LaraT23

They really aren't the same method when you think about it. I also agree with the statement that this applies mainly to quantitative methods. I do gel and tube antibody screens and have not had any issues with citations because it is just common knowledge that they don't correlate. I would definitely challenge that, and if you can drop JCAHO for lab accreditation. We are only CAP and the rest of the hospital is JCAHO. Works very well for us.

Hi Dawn, The only issue I have found when evaluating those Quotient reagents is that we may potentially have patients whose RH histories may change. The Quotient alpha ( blend) tends to pick up D variants and so called "weak" D's on immediate spin. I am working on a recommendation about how to handle these patients so until we get that nailed down we are sticking with Ortho. That and my fridge is full of stock!

We have found that as Malcolm says it was an antibody to the antibiotic in the diluent which by the way is in the liquid in the gel card itself.

Our policy is to allow only 10 days for pretransfusion testing if the patient is not pregnant and has not been transfused in the past 90 days. This is per AABB recomendations and our own experience. If the surgery is delayed beyond that 10 day window, we have it re-drawn. This is also assuming the patient has no positive antibody history.

Funny that this thread is posted today! I had an incident yesterday in which a phlebotomist filled out a blood bank armband using the computer labels as a guide. She then asked a nurse to verify that she had filled it out correctly ( mind you she had not set eyes on the patient yet) and proceeded to enter the wrong room and band and draw another patient. It is just so important being that we are the only department in the lab to dispense something that goes in to a patient that all identification be done by the book with no exceptions. I ask that the staff just write smaller ( ours are hand written) for longer names. The patient listed above was A neg, but typed Opos at first. She had no previous history with us so there were no red flags. Now I have an incident report and retraining and a lovely blood type change error log. Great!!! So after all that, yes do stick to your guns. We have gone one better and asked to use three identifiers, one more than required. Yes, we have had two Bob Jones with the same DOB and sex and even room number( not at the same time!), which is why I required name, DOB, and social security or medical record number.

Yes, I have personally found three different instances of persons with Anti-E in particular with not know or obvious stimulus, much less a pregnancy! In the blood group antigen facts book by Marion E. Reid and Christine Lomas-Francis, Anti-E antigen is listed as having naturally occuring antibodies they can be auto or allo in nature. It also causes only mild HDN if at all. (pg104 ed yr - 1997) In short, tell the doc to watch the patient and evaluate the status of the newborn and decide if he/she is symtomatic, although it should be mild. So that is my two cents.

Thanks Malcolm for constantly reminding me that I really don't have the time to post on this site. Things posted on the fly are evidently not of any use. My mistake, less of me will be seen!

Most of the time ( we do tubes) we see that the back type will have a different appearance in the abberant tube than the real back type antibody. For example, we have patients who have atypical pneumonias who will present much the same picture, but the Anti-B back type looks weaker than the real back type. Also, what about acquired B antigen? Maybe patient is really O and the front type B is bogus? I would try tube testing to see the difference in reactions and also look in to acidified reagents for the B typing. Check to see if the gel card clone picks up the acquired B.

I was wondering if anyone else has seen a unit of blood clot in the dialysis lines during the procedure? A patient over the weekend received only 20 cc of a unit because apparently it clotted off in the venous chamber just before it gets to the patient. I kind of think this is the patient's blood that is an issue but I need to write up a QA report as nursing says the unit clotted. Now, this patient was not heparinized per the nephrologist, so wonder if that makes a difference?

Hey everyone, this patient dramatically improved after giving him steroids for 48 hours and then transfusing slowly. He did better and went home last Friday. We will just chalk it up to one of those blood bank grey area things! Thanks for all of the comments.

I will do you one better! Not only do we get the constant phone calls about information they could look up. We have been asked to call when units are ready on every patient that we set up every day. Talk about a waste of time! Then someone doesn't convey the message, so we put in the computer system who called it to and when ( meditech). Sheesh, talk about spoiled! As if we had nothing better to do:mad:

This just in, his haptoglobin is <10, so definitely some intravascular hemolysis going on. If it were a cold auto, would he have such symptoms in vivo at 37? The DAT might be explained by the nice drip of solumedrol he has had over the past 48 hours. He is looking better and the bili is down to 2.8. The hematologist thinks it is a DHTR, but I cannot for the life of me figure out to what.

Hi Malcolm, I am using polyspecific.

Okay, so let me just say this is my third very odd patient in as many days! Patient has non-hodgkins and severa anemia, is transfused about every three weeks, and has a history of Kell, is A pos. We transfused 2 kell neg A pos units on 02/23 and 1 A pos platelet (pheresis). No issues immediately post transfusion. He returns via ER on 02/28 with a bili of 10.5, LDH of 1550 and pos DAT. Testing in the gel leaves all cells positive. My weekend crew just sent it out, as we are short staffed at that time. I got in Monday and called my friend who is the supervisor of our reference lab, she said that if you just test all of his stuff in LISS and no gel, it is clean. The DAT was still pos with IgG only and showed no specificity. Today I am retesting and his DAT is no longer pos, but every thing in the gel is 4+ and tubes are negative. They looked a bit sticky at 37, but started to fall apart and then at AHG, clean. So, what do you all think is going on? I am thinking meds or mayeb this is just a manifestation of his lymphoma.

We do a full ID if the antibody screen is still positive. There are no exceptions. We repeat patients who are pregnant or have received blood every three days if a product is ordered and we do give a ten day expiration to preop patients who come in at least 7 days before their surgery. In all cases, full ID for positive screens.

In my view, pretransfusion testing is the key thing. We want to make sure that the orders for products are within the criteria to transfuse. If you do post testing and say the patient is still bleeding or has gotten a lot of fluids and is dilutional, what will you do with that information? There are those patients who will not get a good correction of their coagulation testing with product transfusion, and that can be for a number of reasons. This information is really not of that much use if you ask me. Just my 2 cents.

I am one to go with the simplest thing first and not muddy the water with too many panels at first. I have not found many that I think the combination of the ABO, screen cells, and history information is not enough to decide what to do with the specimen. We do just the gel panel A. I look at the screen results and the panel, if things look squirrly, we send it out. Much more time and cost effective for us.

We just use the classic CLSI ( NCCLS) format. I just leave out the things that are not pertinent like reference ranges and criticals in some cases. It works really well for us. I can post an example if anyone is interested.

Our nursing service just orders a msg called request for testing or products and the blood bank tech orders on the correct requisition. We have two expiration date scenarios, a 10 day for our preop patients and a 3 day for all others. The BBK parameters setting needs one or the other and cannot distinguish between the two.

The main issue raised by the administrator was that we have different processes for issuing blood on the floors and for surgery. We require that nurses bring a transfusion record with the patient name, date of birth, medical record number and blood bank bracelet number. For those outlying areas, we just pack up the units that are ordered for those patients, one per cooler and labeled on the outside of the issue sheet wrapped around the unit. The infusion nurses fax over the transfusion sheets as soon as they have finished so that I can get that info into the computer. They don't come and pickup with a transfusion sheet. I also don't ask that surgery does that either. So, different processes make administration nervous.

Here is a scenario, We have an outpatient ambulatory surgical center. We give regular outpatient transfusions pretty much every day to cancer patients, and those with different chronic anemias. We have a hospital courier who takes coolers with blood, all crossmatched and tagged and issued across the parking lot essentially to the infusion area. Our assitant admin. says that this is not acceptable and now wants the infusion nurses to pick up the early ones ( at 7:45 or so) and blood bank staff to take any later ones over there ourselves. Now, we are not a huge facility, so we have one person in blood bank most days and then sometimes someone else in another dept. who can cover for lunch or meetings. My question is, do any of you send blood to outside facilities for transfusion and who takes it? Does anyone know of any standard ( he cites JCAHO) that dictate that only a licensed person can transport blood or blood product?

We just finished our in house comparison and are also using both until our contract with Immucor runs out. I like the Ortho one better, the pos control is much stronger and the field count is smaller if you read the interpretation part. The techs like it because it takes less time to count that way.

Same story here in Texas. Hospital admin put a freeze on overtime and we had to restucture our scheduling quite a bit. We have 12, 10 and 8 hour shifts and it gets a little hairy sometimes with the 12 hour people getting overtime. We don't have a hiring freeze in departments who can show at least 95% productivity. Lab was at 88% over the holidays so we were frozen. We have not had any educational or travel expeditures for a while now and reacently were asked by our CFO to further cut the department budget by 10%. I am looking at new vendors myself.

Our electronic crossmatch criteria are a bit tighter. We use it only in times of massive transfusion, i.e. 10 units or greater. The thinking is that the previous 10 units were all IS crossmatch compatible, so that gave an opportunity to find situations like the one discussed. I do have one question, was the tube crossmatch performed with everything prewarmed? I usually find that if I prewarm the patient plasma, and cell suspension for at least 5 minutes, things tend to present a better in vivo picture if you are having cold reactive issues. Then I also might re-warm the crossmatch, as it does spin at room temp. I also agree with your reference lab, as it is a huge time and materials issue to ID every low incidence and even more so one that seems cold reactive. As far as the card goes, any extra information in Blood Bank helps. It is the lack of info that causes issues. Case in point, a patient with history of antibodies arrived here and was transfused, she was an altered mental status patient who was very anemic on arrival and so did not mention her antibodies ( yes two actually) and we transfused her ( E, Fya) and surprise she had a lovely delayed hemolytic reaction. I would have loved or her to have had a card with her ID.

I think they can put in a volume but I am with christineh, we are waiting to implement but have been told by meditech that it isn't going to be ready until June. We are going live with CS 6.0 in July so I am waiting until at least September to get back on the electronic TAR band wagon!