jalomahe

Do you take temperature of platelets when received from outside blood supplier? Do you take temperature of platelets if they were issued for transfusion but then returned because order cancelled or IV problems or....? What is your acceptable temperature ranges? Current AABB states "Storage 20-24C" and "Transport As close as possible to 20-24C". The "as close as possible" seems a bit ambiguous and confusing as to setting a policy that the techs can follow. Thanks for your input.

We try not to stick the patient a second time if at all possible. If the patient has a historical type performed by one of our facilities we use that. If no historical but the patient had another specimen that is suitable for ABRH testing i.e. a CBC, HH and was drawn at a different time than the current TYSC specimen we will obtain that tube and perform the testing on it. If there is no suitable specimen we can put our hands on and the patient is highly likely to require transfusion then we will request another specimen be collected. Until there is a second ABRH on file the patient receives group O RBCs.

You could still be looking at an additive/preservative issue. You state that Gel testing performed by your site was Grifols and the Reference Lab was Ortho Gel with Immucor reagent red cells. Immucor does not make reagent red cells for use in gel systems so the Reference lab would have had resuspend the 3% cells to 0.8% for use in gel. If I remember correctly that involves taking an aliquot of the red cells, adding saline to make them easier to decant to a "dry" button and then adding MTS Diluent. So you are essentially washing away the additive/preservative in the reagent cells and thereby removing that as a potential problem. The fact that the crossmatch performed in Grifols gel was negative also points to the reagent cells as being the issue. I would suggest that you try rerunning the specimen in Grifols with "washed" reagent red cells to remove the additive/preservatives and resuspend them in the same diluent you use for the donor cells and see what you get. As to the C3d being positive. Have you checked patient's meds list? Some meds cause the DAT to be Complement Positive e.g. antihistamines containing brompheniramine, phyenyltoloxamine

For those of you using automation and especially Galileo Echo users: How do you document daily QC? Do you printout the WBcorQC results, sign off on them daily, and file them for ___ period of time? Do you just have it as a check off item on the Maintenance Log and document review there knowing that 1) the Echo won't let you run the test if QC is not performed and passes 2) the actual QC runs are on the archive disks? Or do you have another method? Currently we print the QC daily but that's a lot of paper and storage space so I'm looking for another way of handling it. Thanks for your help

Way back in 2003, the AABB published "Guidelines for Implementing an Electronic Crossmatch". In the section REQUIREMENTS on page 4 "Additional criteria suggested, but not universally accepted, include: ... The antibody screen should include a three- or four-cell sample." No further explanation was given but presumably it was for the reasons stated above that you are likely to have more cells with a homozygous antigen expression in a 3-cell panel than you are in a 2-cell panel. Most manufacturers of 3-cell panels make sure to include cells that are homozygous for Duffy and Kidd to avoid missing those. So long story short....that's why we use a 3-cell panel as part of our due-diligence of providing blood by computer assisted crossmatch.

In first scenario, Gel negative but tube ICT positive. Was the ICT positive on all cells or just some cells? Did you repeat both Gel and ICT screens to make sure there were no test performance errors. Did you test with with a different set of reagents to make sure reagents had not been contaminated? In second scenario, basically same questions. However if you have reactions in gel with all cells then it might be an Ortho Enhancement Isoagglutination caused by the preservatives in the reagent cells. You can try repeating the antibody screen in gel using reagent cells that have been washed first to remove the additive.

I may go to the extreme but when we receive surveys all of the "patients" are registered in the computer and the appropriate tests ordered. The vials can then be labeled with barcoded patient/test labels and can be scanned. I also enter the "donor unit" into our inventory and print donor unit label for the specimen and place the DIN label on the vial. This way everything is done in the computer just as it is with a real patient. When the tech has completed testing they can print their results from the LIS and if need be I can always go back and look at the results.

When I asked CAP about this they stated that for Blood Bank it only applied to kits that come with their own Pos and Neg QC. So Fetalscreen Kit Yes, Elution Kit No.

Are you trying to make 3% from 0.8% screening cells?

Anyone using Sunquest v8.0 and have a implemented a Group O Policy at your facility. We recently implemented a Group O Policy which states that until such time that the patient has 2 ABRH types on file in SQ that they are to receive Group O RBCs. We have had several instances where the techs failed to follow this policy. It usually occurs with patients who do not qualify for EXM due to no 2nd blood type. The techs forget and grab group specific units for the immediate spin crossmatch. Have you found a way for Sunquest to give a QA failure of some sort when a patient should receive Group O RBCs but the tech allocates Group Specific units instead?

Luckily our Reference Lab allows us to choose only the testing we want them to perform so for Antibody Identification order just that. We send them our results as part of the order and then if they choose to perform a Type & Screen they don't charge for it. If they did charge me for it then I would call to investigate if there was a good reason for them to have done the TYSC. If yes then I'll pass the cost to the patient, if not then I request them to remove it from the bill.

We have a "Special Test B Bank" built in our system (Sunquest) that is solely for billing Reference charges. The test has no CPT code or price assigned. When we receive the bill from the Reference Lab, we order this test and then manually enter the appropriate CPT codes (the test is built to accept multiple codes) for the testing that was performed and the total dollar amount to be billed to the patient. The reference lab we use is very good at getting at faxing us the bill within 24 hours of the workup so the patient billing can be accomplished in a timely fashion.

We would report the gram stain as negative and the culture as positive with the identified organism. Actually blood bank wouldn't be reporting anything....microbiology would since they are the ones performing the testing. Our BB and Micro departments worked together to set up a procedure for handling transfusion reaction workups that required micro so that everything is consistent with best practices. Micro even takes care of notifying the patient physician in accordance with their critical call policy. After they notify the physician then they notify the blood bank so we can notify our blood supplier etc.

We are a similar size hospital as you with a Level 3 Trauma. We use Sunquest with electronic crossmatch. What you are describing as performing the crossmatch at the time of order defeats the biggest advantage of electronic crossmatch ... inventory control. For patients who are electronic crossmatch eligible we only crossmatch the unit at the time the unit is requested to be issued for transfusion. So that clinical staff know that we are not "ignoring" the crossmatch order we created a comment "Blood will be crossmatched when the order to transfuse is released. Contact the blood bank when ready to transfuse." This comment is resulted on the crossmatch order and goes to the patient chart. We have a box on the counter where we issue units that we keep the original crossmatch order in so we know what patients are currently electronic crossmatch. The tech that works that bench goes through it every morning to weed out the ones that are expired. When we receive the transfuse notice we pull the order out, match it to the transfuse order, do the electronic crossmatch and immediately issue the unit to the location (we tube units). If the original order was for more than one unit, we update the number of units on the paper order to reflect how many units are left on the order. The computer of course keeps track of it automatically as units are crossmatched and issued. Works well for us.

RCBCAT is required since CAP specifies that you have to do alternate if there is not a survey available. Now the RBCAT is available, you have to use it ....

20 Weeks. Theory behind it is that the prior to 20 wks even if the total volume of blood from the fetus were to have crossed the placenta and entered the maternal circulation it would not be enough to exceed what is covered by a single full dose of RhIg. Also we only issue full doses, we do not stock micro-doses.

CAP survey RBCAT twice a year, 2 specimens per shipment, multiple antigen typings on each specimen.

CAP also has a separate survey RBCAT (Red Blood Cell Antigen Typing) its 2 shipments a year, 2 specimens per survey and each specimen has typing for multiple antigens

Original validation of serological centrifuge is done to determine the correct RPM (or CF) and time for obtaining the optimal cell button. Unless you do something to the centrifuge that affects one of these two factors then re-validation is not required.

We keep a 5 day red cell blood supply on the shelf. Our blood supplier sets the inventory levels annually based on the previous 12 months utilization. We are approximately 30 minutes from our blood supplier. They stock us daily M-F and then we can submit requests 24/7 if we have a need.

All reagents are QC'd in accordance with the package inserts. We use Immucor reagents so our we use "corQC" to QC traditional reagents (ABO, Rh, antibody screen). We use reagent screen or panel cells for Pos/Neg QC for antigen typing sera. The only lot-to-lot QC we do is for Fetal Bleed Screen Kit with a lot-to-lot QC. We haven't had any problems with CAP inspectors with this QC plan.

First, you have a discrepancy between the Mom's Rh type on the pre- vs. post-delivery specimen. That needs to be resolved just as you would need to resolve an ABO discrepancy. I would suggest that a new specimen be collected from the Mom and tested. If the new specimen's Rh type agrees with the pre- specimen, then it would indicate there was a problem with your post specimen either misidentification or contamination. Repeat the rosette test on the newly collected post specimen. If the new specimen's Rh type agrees with the original post- specimen then you have your answer that the rosette test is false positive due to the Mom having a weak expression of D which interferes with rosette testing. You are not detecting Rh + fetal cells, instead you are detecting Rh + (weak) maternal cells which would explain why the rosette test is positive but the KB stain is negative. You would also then need to follow up as to the pre- sample and whether it was misidentified at collection, etc.

Welcome Skye Unfortunately you have posted your question under the Blood Bank section of this site and I'm afraid we will not be of much help with your question. There is a Micro section on this site. If you click on Home at the top of the page and then scroll down you will see it. The lab department sections are in alphabetical order so Micro is down the list a ways. Hope you get the answers you need.

We do our titers in tube. Years back when a lot of places had switched or were getting ready to switch to gel there was a conversation about the difference in titers due to sensitivity of gel. The basic conclusion at least in our geographical patient care area: we didn't want physicians to be getting different titers from different labs solely due to differing methodologies as it could lead to unnecessary concern/procedures for the patient. So we all stick with tube method. In those instances where we detect the antibody by a more sensitive method i.e. gel or Capture but the titer is negative then we report the antibody titer as less than 1 (<1). Jan

Our irradiation charge is built in the blood component code RAFI is Irradiated Red Cell which includes billing for the red cell plus irradiation plus our processing fee. When the product is issued all is billed. To fix the problem for units going to a patient that does not need irradiation we created two billing codes to back out the irradiated blood charges and re-bill the unit as a non-irradiated unit. CRAFI (credit RAFI) and BRAF (bill RAF). When the unit is issued these codes are used in the pop up charge window. So far it's working for us.