John C. Staley

Mabel, there is always the possibility of physical harm anytime you inject anything into anyone. The Docs can do anything they want in their offices but when they come to my house they must play by my rules. Actually they are not "MY" rules but that's a subject for another discussion. The only time we don't repeat the antibody screen is at delivery and we have a record of a negative screen during that pregnancy. Since they started shipping all of our prenatals out we seldom have any record of the preganacy and even before that a lot of the miscarriages we saw occurred prior to any prenatal care so we didn't have a record of any previous testing. The only miscarriages we know about come through our ER and more often than not it's the first time we've seen them.

The other possibility we have seen is the patient is sharing their medical card with friends and family. You may never know who is the real patient this time.

Mabel, ARUP does the testing 7 days/week. I guess the issue would be getting the sample to them in a timely manner on a week end. Not sure how you could work that one out. Maybe UPS or FedEx overnight or something like that.

I guess I should have mentioned. We always issue the initial RhIG and not wait for the results of the flow from the reference lab. About one per year we have to get a second dose to the patient.

I believe our current protocol is 2 units or 4 hours, which ever comes first.

After providing a glowing report for Helmer freezers earlier I have to confess the past few weeks we have had a problem with ice building up on the fan shroud causing the fan to stop which in turn results in the temp in the freezer to rise above -20oC. The bandaid solution is fairly simple, remove the shroud, remove the ice from the shroud and replace it. We've had the freezer for over 3 years and this is the first hint of a problem. The refrigeration engineer for the hospital is at a loss to figure this one out and I don't know if he has contacted Helmer yet or not ( I have suggested it strongly). Have any other Helmer owners had this problem and if so what have you done?

We've been using our ABS2000 since 1999 and have experienced the occasional problem with reagents but not often. The most recent turned out to be a problem with a lot of indicator cells but that was earlier this spring and I can't see how shipping conditions were the cause, it was cool and mild then. Oddly enough I just was informed that we have been seeing an increase in "invalids" recently and it has been unusually warm in June and July here in norther Utah. When we checked with Immucor they indicated our percentage of invalids was better than most but did not express a lot of concern. It appears to be the control cells that are giving us the current problem. On a side note, we've got our paperwork in for an ECHO. Can't wait to get my hands on it.

We have worked out a deal with our supplier. They have a group of AB donors and the supplier draws apheresis platelets from them for our babies. We have one AB pheresis on the rotator at all times and any baby that needs some get it from that unit. It has work very well for us.

My vote goes with the Helmer i Series as well. We've had ours for a couple of years with little or no problems. Back in the olden days Jewett was the gold standard for blood bank storage but over the past 10 - 15 years they've become a joke of their former self. You are the third facility I know of that has purchased Jewett in the past 3 years and have come to regret it.

I'm with Mabel. Our cell washer produces a dry enough button.

We send the sample to ARUP in Salt Lake City, UT. It's just 40 miles down the road from us. They report it as a percentage just like the calculations for KB only more accurate, at least that's the story. We then calculate the rhIG dosage just like we did when we were doing K-Bs.

We still do K-Bs for trauma and such to determine if baby is bleeding into mom. No counts, just are there fetal cells or not. We don't do them to determine RhIG dosage. For that we send positive screens to the local reference lab for flow.

Hey don't give Mabel all the credit. I had the same thoughts, she just beat me to the key board. I was busy saving lives while she was surfing the net. HAHAHAHAHAHA Some times I just crack me up. Good work Mabel and thanks for the info Bob. We have a cath lab but have never seen this. Maybe if we do I'll have the rare good fortune of remembering.

There was a recent AABB teleconference presented by John Judd on this very subject. You should be able to get a copy of the slides and a CD from AABB. That should get you on the right track. We still weak D test every D neg patient. I have discovered that inertia is the single most powerful force in human nature. Trying to over come it in our organization is an impossible task. This is one battle I have given up on.

Bob, Now I know where I'm going next time somebody tries to tell me there is a shortage of O negs!!! I knew it was a fairy tale and some troll under the bridge had them all. ;>)

Our preferred RBC product for NICU is type specific, CPDA-1, Leukoreduced and Irradiated. We try to set it up for the baby as early as possible and will use it until it is gone or outdates. We can not irradiate (long story) so we have to purchase the blood already irradiated and the blood supplier is too far away to order as needed so we keep a couple of Os and As both pos and neg that meet the above requirements on the shelf at all times. As a general rule if they have been on our shelf for 7 days and not assigned to a baby they are replaced with fresher units. Luckily we have enough call from oncology for irradiated units we don't waste many. Each baby gets their own unit with the exception of twins, triplets, etc. Our neonatologists like to have all babies from multiple births on the same unit if the types allow. I think this is to minimize donor exposure to the "family" but I'm not real sure. I've heard of places where this is strictly forbidden. A different philosophy of not wanting all of the family exposed to the same donor. I guess this is a matter of how your neonatologists feel on the subject. We absolutely will not use a cord blood sample for pretransfusion testing. (labeling concerns!!!) We get 3mls drawn from the baby in EDTA. That is usually plenty for a type and screen. If the antibody screen is positive we will use mom's sample for antibody ID.

I would suggest making an extra effort to audit those units that transfuse rarely such as peds and L&D. They are the ones most likely to have problems. Places like ICU where they transfuse every day have very few problems because they do it so often. My biggest problem is the OR. They are special!!! They can't get anything right and I can get no support to get them to comply. The sad thing is, it will take a significant event to get their attention and even then they will shift the blame faster than a politician and accept no level of responsibility. Oh well such is our fate.

Glad you stopped in Lisa and after the Jazz beat the Spurs we can be friends. :>)

I'm curious, who asked for this indicator? I'm with Bob. My staff is under enough pressure to just do their job error free 100% of the time. What more do they want!!!

Currently we routinely test babies from Rh Neg moms. Trying to get that reduced to just Rh testing. Of course the physician can order anything they want on specific babies.

Cliff, don't you think that for this type of project 666 would have been a more appropriate number than 660?

Our blood supplier is charging are "Rare Fee" for some units of antigen typed blood. If you are getting such a charge how do you pass it on to the patient?

We see weld failures so rarely it's not worth the effort for us to bother with hemostats. If the weld does fail we give everything a 24 hour outdate and move on. But...... in my humble opinion, the hemostats seal it off. The integrity of the closed system is not breached. Seal both sides, separate them and try again.

I appreciate the input. My clinical engineer installed a two way valve in the saline line so we can easily switch between the saline cube and the wash solution. It works great and makes the weekly flushing much easier. Looks like once again I fall in line.

Looks like you had a lot of fun. I have to say that this was one of the best Lab Weeks we've had. The lab had gone through a great deal of stress and change the past year with all of our out reach going to a new corporate central lab. We lost folks, some transferred to the central lab, others just went else where. Those left felt like they were living in a washing machine on the agitation cycle. Lab week came about a month after everything had finally fallen into place and it gave everyone a chance to relax a little and even, laugh, which had not been heard for a long time. The bulk of the credit goes to two very imaginative techs and one incredibly bubbly specimen processor. (I think she shared her medication but I'm not sure on that.) Anyway Lab week was a great success here.