[December precipitation in the Northern Hemisphere]

In case you were wondering, it's still snowing outside my window.  

[December precipitation in the Northern Hemisphere]

It is outside my window!!  

[Wondering if it's just me .]

Each day, when you first see the PLT icon on your computer is your first thought Platelets???  

[Which babies do you do "Cord Blood Workups" (Type and DAT) on routinely?]

On 11/18/2019 at 8:10 AM, NicolePCanada said:

If we only do D typing on babies from D negative mothers and a weak D or Du test needs to be performed, the results of the weak D is only valid if the DAT is negative, so a DAT would need to be performed. Therefore, an ABO and DAT would be a good place to start. Just my thought.

And just how often are you doing the weak D test on theses newborns?  Is it often enough to justify the additional testing?

[Which babies do you do "Cord Blood Workups" (Type and DAT) on routinely?]

I would think that a 4th option in the poll should be: Routinely perform only D typing on babies from D negative mothers.  

Why do ABO and DAT routinely on these babies?  

[Whole Blood Compatibility Testing]

10 hours ago, longhorn2891 said:

  Our institution wants to start stocking low titer group O whole blood.

I'm curious and have been out of the loop for a while so I would like to know who and why.

[New sample collected within 3 days of a current Type and Screen]

I agree with David on the 1st part of his response.  New samples would get everything (except known antibodies as David stated) and you reset the clock.  As far as the second part of his response, I never had the "pleasure" of dealing with a super responder so I'm not sure how I would have dealt with that.   

[Positive Cord DAT, RH= mom, Allo-D and Rhogam]

On 11/5/2019 at 8:33 AM, JJSPLAYHOUSE said:

I actually just found out that she had a negative ABS on 5/24/16, fetal screen bleed of 45 mL and one rhogam shot was injected. Next ABS was 6/23/16 where Allo-D was entered because it could not be ruled out.

Based on on of this I would be inclined to believe she never had an allo anti-D. 

I am tempted to climb on my soap box and spout a heated diatribe on the prenatal practice but I think I'll skip that this time.   

[Positive Cord DAT, RH= mom, Allo-D and Rhogam]

Did the "consistent prenatal care" include an antibody screen at some point??  I've seen anti-D drop below detectable levels but not that quickly and not in a young person.  If this pregnancy had a negative antibody screen I would question the results from 2016.

[COBE Cell Washer QC]

Times and focus change.

[COBE Cell Washer QC]

Just curious but did the inspector mention why you should check the total protein?   

[Sending Blood Products via PTS]

5 hours ago, David Saikin said:

Why is the blood getting warm a problem (how warm is too warm)?  It's signed out; it's going to get warm.  The tube is not storage.  Don't need to maintain storage temp.

Good point David,  My first thought was, "why is your tube system so slow?"  Granted I have a fairly limited exposure to tubing blood but in what experience I've had I've not seen a tube system so slow the blood would get out of temp during transport.  

[Positive Cord DAT, RH= mom, Allo-D and Rhogam]

Can you give us anymore info on what was going on in 2016?  Also, what level of prenatal care had she received, if any?  

[Direct entry of manual testing results into LIS]

I'm with David on this one.  Doing both paper and computer entry just adds one more opportunity for mistakes.  If you can't trust some one to put it in the computer correctly how can you trust them to write it down correctly!  The key is the ability to enter the results as they see them and not have to walk over to a computer station to do it.  Also, if you are entering from an instrument print out I highly suggest you get that instrument interfaced as quickly as possible.  Again, you are entering results from paper and that should be avoided.   

[What in your MTP?]

I think I missed something.  Did you really imply that you are putting platelets in the same cooler as the RBCs??  

[Cardiac surgery and what it means for our blood bank?]

From my experience a lot depends on the team of surgeons and their philosophy and training in respect to transfusion.  In the last facility I supervised the blood bank in we had a group of surgeons who believe the less transfused the better and they rarely transfused anything.  About the only time they actually used any blood products was during a "redo".   It didn't hurt that my blood bank medical director was married to one of the lead surgeons.

 On the other hand, a sister hospital in the same corporation about 60 miles away used a lot of products on virtually every procedure, especially platelets.  They would use more platelets in one procedure than we would in over a year.  

The suggestion to be involved in the initial meetings is an excellent suggestion.  It's the only way to find out the surgeon's expectations ahead of time.  

[negative Cord DAT, positive eluate]

I have to ask, how many times when the DAT is negative and you can elute the antibody from the babies cells does the infant show symptoms of a significant case of HDN (old guy, old nomenclature) resulting in an exchange transfusion or even phototherapy?  Seems to me you are doing an awful lot of work for little, if any, benefit.  See Malcolm's technical discussion above.  

[Bags for transporting blood products at issue/dispense]

If you put "Secondary Blood Bags" in the search box you will find a past thread on your question.  

[Blood Banker]

As long as you validate/verify the digital, I believe annually is the requirement, you should be fine without a second thermometer hanging around waiting to get broken.   

[Give E and c negative units?]

10 hours ago, SMILLER said:

This goes back to some comments made earlier in this thread.  It is impractical to screen for all antigens for a particular patient that may induce an antibody response.  However, for a patient that is actively producing (or is known to have produced) an antibody for a particular antigen, transfusing known antigen positive blood would clearly not be indicated if it can be avoided.  

Scott

So...... utilizing the same scenario, are you going to screen every pretransfusion patient to determine their K status to determine if you can use those K+ units or just throw them away, it might be cheaper or just let them set on the shelf until a suitable patient comes along to use them on or are you going to extensively antigen type every patient with one antibody to determine what else they can make and then screen every unit for them for antigen compatibility???  I never had enough staff to accomplish this kind of CYA!  

 

[Give E and c negative units?]

3 hours ago, SMILLER said:

Except that if you know the patient has been transfused in the past, and now has anti-E, and you also know they are c antigen negative, it would be nice if you could avoid having them produce anti-c.  You already would know that they are a responder, and for future transfusions (for, say, a chemo patient), it would be nice if you did not have to screen units for little c.

(Extended phenotyping of patients to avoid transfusing certain types of blood is indeed done for certain cases, such as Dara or sickle-cell patients.)

Scott

Scott, you are kind of contradicting your self here.  In one sentence you are advocating avoiding the production of anti-c which can only be accomplished by screening units and transfusing c= units.  Then you say it would be nice if you did not have to screen for units.  I see a conflict here.  Bottom line, it's a gamble.  Either you screen for c= units now to prevent anti-c  or you take the chance they won't make anti-c and if they do you start screening units then.  The latter was always my choice. 

[Massive Transfusion - who do you call for additional help?]

Just curious but are you referring to a single patient massive transfusion or a mass casualty situation?  I would classify Malcom's examples as mass casualty while a single patient massive transfusion could be the result of any number of things.  Then there is everything in between.  In the two facilities (both approximately 350 beds) I supervised I left it up to the staff involved to decide what and when they needed help.  When help was required I was usually the first one called.  Even got a call while fishing in Alaska once.  Wasn't much help with that one.  

[Rh negative Patients that receive Rh positive blood]

I'm sure Malcolm can give you the hard numbers and details but keep in mind that not every D- person responds the same when given D+ RBCs.  Some will develop anti-D with as little as 100 microliters of cells or less while others will never develop anti-D no matter how many units of D+ RBCs they receive.  Then everyone else is scattered around in between these 2 extremes.  Then throw in the males and women who are beyond child bearing and it becomes even more complicated.  I fall into the category believing that try to prevent the formation of anti-D after a transfusion event, especially one of multiple units is counter productive and an effort in futility.   

[Management Question]

6 hours ago, Ghandi said:

So the best answer to choose is A.

Thanks everyone 

Actually, if you look back at the responses you will see that the best answer is all three in the proper sequence.  

[Patient Blood Management]

Thanks for the Info Neil.  I appreciate you taking the time for the explanation.  I'm happy to see things moving forward even if I'm no longer actively involved.  It sounds like something I could get behind.