[Specimen Labeling]

We use computer generated labels (our two identifiers are Patient's Full Name and Medical Record Number), with collectors initials and date/time hand written on the sample at the patient's bed side . We also have a second ABORh verification policy.

[IS with AHG crossmatch]

I suspect that noone has been cited by CAP because CAP is a peer inspection and most of us do not think an IS crossmatch is required when you are performing an AHG crossmatch and entering results in a LIS.

We recently completed our joint AABB/CAP inspection, though the question of IS crossmatch in addition to Gel crossmatch was brought up for patients with antibodies referencing CLIA regulations, there were no citations. Our computer system is validated for electronic crossmatches and we perform gel crossmatches only for patients with antibodies.

[Just For Fun--Blood Bank Quiz Game!]

Human urine is okay, but guinea-pig urine is even better. Collecting the guinea-pig urine is the problem!

There is a high-incidence antigen within the 901 series. About half of those found to be negative for the antigen are Japanese.

What is this antigen?

:confused::confused:

Is it Antigen Jra? (Not sure of the answer)

Q. What is elevated in Pre term infants: PT or PTT?

[Pray for ME]

Just signed up to sit for my SBB. I think I may be insane, been a blood bank lead tech for 10 years but I've been out of school for 15 years. A supervisors job was offered if I can pass the SBB so every one cross your fingers.

Good Luck to you.

The Method and Appendix sections of the Technical Manual are a must for any SBB review.

[Great Computer System]

We have SoftBank version 23.1.2 and are happy with it. It took us about a year to get comfortable with it. We transitioned to Soft from Hemocare.

Some of the limitations we have created workarounds for are:

Access to the same patient at the time of Emergency Release is a problem, unless each user has their own network account.

Electronic crossmatch is not possible when Rh negative patients are getting Rh positive blood.

System does not differentiate a cellular product vs. non cellular product for Leukoreduction and Irradiation.

Limitation of ten blood product request to the same pre analytic sample, unless built as an add on product order.

[OK, on to bigger and better controversies]

Thanks to so many of you for your input to my question about sharing records when you purchase a new Hospital (which opens this Sunday, and NO, we did not get their records).

Next question: Again, with 26 years and 6 Institutions, I can be a stickler (but at the same time, usually have a good pulse for the standard of practice). Our current issue of discussion at my Hospital has to do with specimen labeling; what is required and what is acceptable (to me, they are one and the same). In my experience, it is not uncommon for the Blood Bank to have stricter specimen labeling policies than other areas of the Lab; however our QA coordinator is stating that what is acceptable for one dept., should be acceptable for all depts.; OK, that's fine with me then, as long as all other depts.have my standards )!

I go strictly with the AABB Regulation 5.11.2.3; in summary, we should only accept what is complete, accurate and legible.

So, when I quote that, I am then told that "complete" is relative; that is is just a guideline.

One last insert before I state "my" requirements: I know that some places who use Red Armbands for BB draws, allow the Red Armband# to be 1 of the 2 unique identifiers. I spoke previously with both an FDA and AABB Inspector regarding this in that "my" feeling is that a number that is just stuck to a tube, does not "uniquely identify a person." If I call another Hospital and say I have their patient and want to know their antibody history, they are not going to ask, "Ok, what is their red armband#?!" The Inspectors I spoke to, agreed with that (though I see the Technical Manual lists it as a possible identifyer; so this is just my bias).

I want FULL Name (to be complete), and FULL MR# or D.O.B. as the 2nd identifier. I recently took a specimen back to phlebotomy, noting that the complete name was not there; they said it was; I said it was missing the last letter; I won't repeat what they said......

How about all of you; what are your thoughts/biasis/requirements for specimen labeling for the Transfusion Service.

Thanks!

Brenda Hutson, CLS(ASCP)SBB

Brenda,

We require patient's Full last name and first name as it appears on the patient's armband and Medical Record Number/DOB, with the date, (time optional), and signature/initials of the collector on all the samples for the Laboratory services, including Transfusion Services. There are no exceptions for Blood Bank samples, all the required information must be on the sample.

What helps us with the compliance is the NJ Department of Health Mandate for (N.J.A.C. 8:8 Collection, Processing, Storage and Distribution of Blood) Processing Blood Product recipient samples, which clearly states the above requirements. See if the below URL is of any use to you.

http://nj.gov/health/phel/bbank.shtml

Kashmira

[Isensix Temperature Monitoring System]

Does anyone have any Performance Qualification (PQ) validation protocol for Isensix Wireless Temperature Monitoring Systems? What needs to be included in this?

How much PQ needs to be performed in-house after the vendor performs OQ and IQ?

Any help or procedures related to this will be greately appreciated.

Thank You,

Kashmira Patel MS MT (ASCP) SBB

[Irradiated orders]

We have a multi-tiered mechanism for identifying patients who require irradiated blood. Once identified, we issue only irradiated products even if the order is written for "red blood cells" or "platelets". Our experience is "irradiated" is seldom specified when needed. There are many reasons...heme/onc docs know we will issue irradiated products once we are alerted the first time, the patient may come in under a different service that has no knowledge of the need for irradiated products, or simply the MD "forgets". Our compliance folks think we should contact the ordering MD and have them cancel the red cell order and re-order irradiated red cells. I see this as causing unnecessary delays. Tracking down the ordering physician is not always an easy thing. My proposal is to have the Medical Practice Committee approve the list of indications for irradiated blood, allowing the blood bank to modify an order as needed. We meet with compliance on Friday. How are others handling this?

We have similar expirience as you with regards to Irradiated Blood and Blood Products. We are a teaching hospital and a lot of blood products orders are placed by residents or unit clerks on behalf of the physicians. Our transfusion Committe has aggreed to a list of indications which require irradiated blood and it is a part of the blood transfusion guideline provided to the physicians and is a part of our SOP. Once a patient is identified from the list as requiring irradiated blood products, we get a corrected order from the care giver which may be the patient's nurse,who in turn contacts the appropriate physician.

[2009 cfr (fda)]

Thank You

[Reaction Protocol]

Does anyone have a reaction protocol specific for plasma or platelets? We had a patient over the weekend and a workup was requested for a plasma transfusion. I was away(of course) and would like to provide more speicifc guidance in the protocol.

:juggle:

We are a teaching hospital and Level 1 trauma center, and we do get multiple suspected transfusion reaction workup requests to FFP's and Plateles. We get the product back to Transfusion Services, after Suspected TR work up is initiated by the blood bank physician and bed site physician. Unless a blood culture is requested, we only perform clerical checks on the product in question, which includes a review of transfusion tags, product appearance and labeling. A blood sample is not collected unless requested by the blood bank.

If a TRALI or platelet antibody is suspected the blood bank medical director reviews the patient chart requests a platelet antibody screen which is done inhouse. Rest of the TRALI workup is done as per the blood center's protocol.

[Trm.40500]

Ned,

At present we have a some what similar process like you at my present institute, we keep our PAT samples for 30 days pre-transfusion. On the day of surgery the patients are asked to bring a duplicate copy of arm band given to them at the time of sample collection back, as a verification process and a siganture that verifies that there was no transfusion or pregnancy within the last 3 months. After the receipt we change the sample outdate to 3 days.

If the patient forgets arm band we recollect the sample for compatibility tests.

I am new to this place, and position and still in the process of familiarizing myself with the required regulations. Our OR and anesthisia physicians are giving us a hard time with arm band check procedure in place. Their argument is why are we getting a new sample, if the patient forgets the armband and if they have performed the patient's identification by the drivers license and / or other means.

If you have any regulatory requirement relating to this, it will really help us tremendously.

Thank You for time and help,

Kashmira

There is probably no tecnical reason for a time limit on the crossmatch when there has been no transfusion or pregnancy. There is a requirement to hold samples for seven days post transfusion; so most places have set up a protocol to store samples ten days or more. We set the limit for crossmatches to be 3 days, and the maximum for extending the crossmatch (with approval by the Medical Director) at 7 days. Then we set up a retention system of 14 days for pre-transfusion samples, which covers even the extended crossmatches without our having to retrieve individual specimens and store them separately. As for the Arm Band, the Patient is required to retain the Identi-Print card to be re-attached to an ID bracelet on re-admission. No card, we release the crossmatched units and re-do (and charge for the work). All this is spelled out in the crossmatch procedure (which the Techs see) and the Specimen Collection for Pre-Transfusion Testing procedure (which Processing and Admitting Personnel see). You should also define the limit for performing antibody screens (48 hours) and for elutions in case of Positive DAT and history of recent transfusions. For the latter we use 90 days mostly based on tradition.