jalomahe

I just had this conversation with the CAP .... 
Here's may question and CAP's response:
My question -- RE: COM.04250 Comparability of Instruments/Methods I need clarification on this for the Transfusion Service. Since antibody screen and antibody identification TESTS both use the same METHOD do you have to perform correlation on both TESTS or just on the METHOD? In other words do I have to do the CAPTURE antibody screen and compare it to the PeG screen and then also do CAPTURE antibody identification (which is the same method as the screen, just with more cells) and compare it to a PeG antibody identification (which is the same method as the screen, just with more cells)?
 
CAP response -- If you compare the antibody screen methods, you are correct, that covers the antibody identification as well.
Sincerely,
Kathy Passarelli
Technical Specialist, CAP
The intent is to compare METHODS so if your antibody ID on the instruments are performed by the same METHOD as the antibody screen then you do not need to perform an antibody identification as part of your instrument/method comparison....just the antibody screen will suffice.
Ditto for comparing your manual method, if your manual antibody identification is performed by the same method as your manual antibody screen then you just have to do the antibody screen and compare it to your instrument method.
 

I just had this conversation with the CAP .... 
Here's may question and CAP's response:
My question -- RE: COM.04250 Comparability of Instruments/Methods I need clarification on this for the Transfusion Service. Since antibody screen and antibody identification TESTS both use the same METHOD do you have to perform correlation on both TESTS or just on the METHOD? In other words do I have to do the CAPTURE antibody screen and compare it to the PeG screen and then also do CAPTURE antibody identification (which is the same method as the screen, just with more cells) and compare it to a PeG antibody identification (which is the same method as the screen, just with more cells)?
 
CAP response -- If you compare the antibody screen methods, you are correct, that covers the antibody identification as well.
Sincerely,
Kathy Passarelli
Technical Specialist, CAP
The intent is to compare METHODS so if your antibody ID on the instruments are performed by the same METHOD as the antibody screen then you do not need to perform an antibody identification as part of your instrument/method comparison....just the antibody screen will suffice.
Ditto for comparing your manual method, if your manual antibody identification is performed by the same method as your manual antibody screen then you just have to do the antibody screen and compare it to your instrument method.
 

LOL!  We would send it to our reference lab!  We have other things to do here...
Scott

Great feedback. Thank you.

When tube testing was all we had, my moto was; "when in doubt, shake it out!"  One of the first things I did as transfusion supervisor at a new facility was convince the medical director that we needed to stop using the microscope for routine testing.  It was much harder to convince the rest of the staff.  I couldn't remove the microscopes from the department because we were doing KBs at the time and I'm pretty sure a few of the "older" staff still used them for routine testing when I wasn't looking.  Once again inertia is proven to be the most powerful force in the universe!
 

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
 

Patient first and last initials and reagent in the tube so for blood type it would be: JH-A, JH-B, JH-D, JH-DC for the front type and JH-AC, JH-BC for the reverse type.

Patient first and last initials and reagent in the tube so for blood type it would be: JH-A, JH-B, JH-D, JH-DC for the front type and JH-AC, JH-BC for the reverse type.

We have Epic 2018a with Sunquest v8.0. They are working well together but always a work in progress. Nursing is using Epic BPAM so they are doing barcode scanning of the units at bedside so we are now able to issue blood product without any paperwork other than the patient/unit identification tag on the unit. We are in the process of piloting the same process of blood transfused in the OR given by Anesthesiologists. Next up is creating process for rapid scanning during Massive Transfusion.

We are using Echos and prior to that we had a Galileo. There's an interesting phenomenon that can occur with automated solid phase that can cause a positive screen and then a negative panel. I have personally seen it happen at least twice. If there are bubbles/foam on the top of the specimen the instrument will pipet the bubbles/foam and this underpipetting of specimen can actually cause the absc to be look positive. When the panel is performed, the bubbles have already been removed and the instrument pipets the plasma correctly, the panel is negative. All of our techs are taught during training to inspect the specimen for bubbles/foam prior to placing on the instrument but sometimes it is a step that is overlooked when it's busy.
Another cause of false positive can be using cold undermixed indicator cells. If a new bottle of indicator cells is placed on the instrument without allowing them to warm the cells may not resuspend completely prior to being pipetted. Since the instrument pipets from just below the surface of the reagent it's possible to not have the proper amount of cells. This also occurs when bottles are loaded without a stirball having been added to the bottle.
Just a couple of other ideas for troubleshooting.

If the total inventory is only 6 units at a rural hospital, I would stock 4 O Pos and 2 O Neg. I'm not suggesting every hospital should stock only 'O'!

I would probably switch my inventory to stock only 'O'.  

I must respectfully disagree with Malcolm (a rare occurrence).  In my transfusion service we documented the time of issue as the time the blood product left the blood bank and became the responsibility of the nursing service.  Maybe this is one of those things where we have 2 countries separated by a common language.  
From Merriam-Webster
Definition of issue (Entry 2 of 2)
transitive verb
1a: to put forth or distribute usually officiallygovernment issued a new airmail stampissue orders b: to send out for sale or circulation : PUBLISH cBritish : PROVIDE sense 1a, SUPPLY  

If you feel that you are not being heard or appropriate action is not being taken you have the option of reporting to your accrediting agency AABB, CAP, TJC. This can also be done anonymously. The agency will contact the lab for information/investigation.
If patient safety is being put at risk then you need to do everything you can to get these situations addressed which it sounds like you are doing.
The other thing I would highly recommend is that you keep written/hard copy documentation of everything. You may need it sometime in the future to have proof of your diligence in trying to force compliance. Always remember the old adage "If it's not in writing, it never happened"
Good luck

If you feel that you are not being heard or appropriate action is not being taken you have the option of reporting to your accrediting agency AABB, CAP, TJC. This can also be done anonymously. The agency will contact the lab for information/investigation.
If patient safety is being put at risk then you need to do everything you can to get these situations addressed which it sounds like you are doing.
The other thing I would highly recommend is that you keep written/hard copy documentation of everything. You may need it sometime in the future to have proof of your diligence in trying to force compliance. Always remember the old adage "If it's not in writing, it never happened"
Good luck

If you feel that you are not being heard or appropriate action is not being taken you have the option of reporting to your accrediting agency AABB, CAP, TJC. This can also be done anonymously. The agency will contact the lab for information/investigation.
If patient safety is being put at risk then you need to do everything you can to get these situations addressed which it sounds like you are doing.
The other thing I would highly recommend is that you keep written/hard copy documentation of everything. You may need it sometime in the future to have proof of your diligence in trying to force compliance. Always remember the old adage "If it's not in writing, it never happened"
Good luck

If you feel that you are not being heard or appropriate action is not being taken you have the option of reporting to your accrediting agency AABB, CAP, TJC. This can also be done anonymously. The agency will contact the lab for information/investigation.
If patient safety is being put at risk then you need to do everything you can to get these situations addressed which it sounds like you are doing.
The other thing I would highly recommend is that you keep written/hard copy documentation of everything. You may need it sometime in the future to have proof of your diligence in trying to force compliance. Always remember the old adage "If it's not in writing, it never happened"
Good luck

If you feel that you are not being heard or appropriate action is not being taken you have the option of reporting to your accrediting agency AABB, CAP, TJC. This can also be done anonymously. The agency will contact the lab for information/investigation.
If patient safety is being put at risk then you need to do everything you can to get these situations addressed which it sounds like you are doing.
The other thing I would highly recommend is that you keep written/hard copy documentation of everything. You may need it sometime in the future to have proof of your diligence in trying to force compliance. Always remember the old adage "If it's not in writing, it never happened"
Good luck

If you feel that you are not being heard or appropriate action is not being taken you have the option of reporting to your accrediting agency AABB, CAP, TJC. This can also be done anonymously. The agency will contact the lab for information/investigation.
If patient safety is being put at risk then you need to do everything you can to get these situations addressed which it sounds like you are doing.
The other thing I would highly recommend is that you keep written/hard copy documentation of everything. You may need it sometime in the future to have proof of your diligence in trying to force compliance. Always remember the old adage "If it's not in writing, it never happened"
Good luck

A true trauma stat (not a drama trauma) is 60 minutes for ABSC and 35 minutes for ABO, from receipt in lab.  All other stats are 65 minutes for both.
We batch our cord bloods and do them every 4 hours.  The nursery has it in their brain that it must be completed by then in order to treat the baby accordingly.  Of course, when they don't send it down for 3 hours and miss our run time, they get mad at us.

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.   

We went through this a few years ago.  The problem with any kind of written worksheet is that it becomes your primary record -- the computer entry is secondary. -- resulting in both sets of records must be retained.  When results are directly entered into the computer, almost all written testing records are not needed.
Scott

Hello Pmanager,
ISBT 128 does not preclude the use of an additional label on top of the ISBT 128 label, such as the “Irradiated” label you referenced, as long as it does not obscure/cover any of the ISBT 128 information.
I hope this helps!
Kind Regards,
Kaytee from ICCBBA (Organization that maintains and develops the ISBT 128 Coding and Labeling Information Standard)

We have a policy to offer RhIg if we have given Rh Positive Random Donor Platelets to an Rh Neg female of childbearing potential. The amount of RBCs in a platelets is normally less than can be covered by a single dose of RhIg unless the platelets were particularly bloody in which case we don't accept them from our supplier. Luckily these days our supplier is doing a great job of supplying only Single Donor Platelets so bloody platelets are not an issue. Giving enough RhIg to cover a RBC transfusion would not be a reliable or economically feasible option since the RhIg we have on hand only covers 15mls pRBCs. So a one (1) standard unit of packed RBCs would take in excess of 18 doses. As Malcolm said giving the RhIg would have the added downside of clearing the Rh Pos RBCs you just gave so unless you have additional Rh Neg units available you are just putting yourself behind again.

We use plain old plastic ziplock bags. Not so much for the safety of the transporter but in the event they drop the bag and it happens to break.