COTTONBALL

Hi Sara. We use Rovers, and EPIC at our facility, and I agree with all of the great responses given in this thread. I am AABB member, SBBcm with 34 years in the business (almost all experience in hospital Transfusion Services Trauma centers across the country). To this day, I still feel uncomfortable with the standard mentioned above (specifically #3 Retesting the same sample...) because of the possibility of Wrong Blood In Tube (WBIT). Positive Patient Identification (PPID) and the use of electronic hospital bracelets as risk reduction strategies are as good as the individual (s) performing the phlebotomy, as good as the individual (s) donning the correct hospital bands. Trust is a Must. Get to know, and audit your collectors (RNs and Phlebotomists). Make sure they are performing EVERY step in PPID as expected. Make sure they (especially phlebotomists) know how much you appreciate and rely on them (our frontliners) to get it right. At the same time, DO NOT be afraid to hold them accountable, and report deliberate (at risk) behavior. I've seen it all, and happy to say, I can rest with our current crew. My apologies for being so lengthy, but It's been awhile. Have a good evening. No spellcheks please. Cottonball.

I am having a hard time understanding why the pharmacy has to play any part in storing, labeling, issuing this plasma product. Are they doing the same for other products we modify in the BB? I am ok with the albumin, coag factors, even RHIg, but don't get the Pharm as middle man for handling/distribution of any products we thaw/modify in our BB/TS.

Hello So, to my knowledge and 3 decades of experience, there is no specific Standard that will specifically tell you how long reagents can be stored outside of the environment suggested by the manufacturer of that reagent. There are a few relevant standards on reagent receipt, use, handling, and storage in the AABB 32ND edition, pgs. 7, 10, 12, 15, 35, 39. Page 10 also refers to reagents meeting or exceeding FDA... One standard - (AABB 5.1.8) Handling, Storage, and Transportation only states that you shall have a process to ensure that critical materials (including reagents) are handled, stored, and transported in a manner that prevents damage, limits deterioration,... Bottom line, the manufacturer in most cases are very specific about what not to do ( do not freeze, dilute, or use beyond expiration date.), and will not entertain a question about how long one can leave the reagents outside of what they have already stated (store at 1 to 10 C when not in use). In the old days, we use to have working reagent racks out all day, with tiny cool packs embedded in the racks. The concern was really with the reagent red cells growing bacteria causing a lot of false positive antibody screens. Sorry for long email. I hope you get something out of this. Connie

32 years of hospital TS, multiple facilities and states. I have seen a lot. We- Never accept outside Blood Types. Always honor other facilities non-ABO antibodies (unless it does not make sense). Never type the same sample for ABORh Confirmation (do not agree with the AABB on that one.), Electronic bracelet or not. WBIT is real. Never bill for ABORh Confirmation, as we should get it right the first time. It's standard of care, so not billable here.

Hello, thanks for your post. Anything is possible every single time we administer blood products. I agree with Neil, especially on the patient's history inquiry. I would be more concerned about other infectious bugs, than with possible rare reactions due to IgA deficiencies, and even then, I am not too concerned. At this point, an injection of CCP and prayers are in order. Patients are responding. Good day.

Dearest Malcolm, THANKS for all that you do.

Hello. We also use the Echo (Liss) as primary method, and PEG tube testing as secondary method. For crossmatch through Coombs, we use PEG as potentiator. Forgive me, for I have been in the business 3 decades next month. The use of current terminology, I am still working on. cottonball

Hi StevenB. Thanks for your input. The last time I prewarmed anything was about nine years ago. Prewarm techniques are not performed as much anymore in the hospital setting. However, every TS I have been a part of still has an SOP for it. In the past 10 years I have not had a whole lot of solid Blood Bankers (very slim pickings). New techs are afraid, older techs do not want to change with evidence-based anything. Yes. I agree on being strict. My techs will probably tell you that I am strict (very, very strict) in how we practices. Also, I have never heard my reference family (ARC) ever mention the words "prewarm" verbally nor in writing. I am just glad that they provide additional guidance, especially when I am not present. On your recommendations, I will continue "strictness" Kind regards,

Oh! In reference to calling HLA antibodies, after ruling out the common clinically significant antibodies to antigens on panel cells with confidence, we would still call for example, possible Bg, possible low prevalence, non-specific, etc. Our IRL does not want these, and will guide techs when needed.

In my decades of hospital transfusion services, I like to say that I grew up surrounded by some of the most competent, highly-skilled blood bankers who performed every test in the books. In the hands of the right folk, and that applies to any test/method, pre-warm, like any other technique can be performed with confidence. Just my thoughts. I know the detection and id of antibodies have been missed in our BB/TS world, but I have always been comfortable with the prewarm technique. When you suspect, pre-warm, and can then see clearly the anti-E pattern, this use to be gratifying. In 2016 should I be afraid that I may have missed something else/prewarmed it away? I am asking because I have 20 generalists rotating through Blood Bank and I value your input. I have only been here 8 months, with about 10 strands of hair left (9 as we speak), but that's ok, cuz we love what we do, RIGHT? I digress. The last SBB has a written procedure for Prewarming, however, preceding this is a page stating basically that prewarming can kill. Back to sleep one more hour, I hope this makes sense. Sincerely.

I have to say, all of the questions and answers here are great. I get calls from my techs who are very fearful of those least incompatible/compatible reactions on crossmatch, even after our reference buddies have detected no underlying alloantibodies. I appreciate Malcolm's care in saying "in the right hands". Competency and proper training is everything. I fell in love with antibodies/antigens/panels/elution/adsorptions.. 26 years ago as a student. However, today I (hospital TS) trust and rely heavily on the expertise of our reference family. Have even delivered chocolates to them once a year. Thanks for all that you do.

I will be attending Sunday and Monday. It would have been nice to have some "Pathlabtalk" t-shirts, water bottles, sunglasses or something to easily recognize you good people. I will check back in tomorrow. Hilton properties near the convention center are nice, so are the breads and wine.

I will be there.

Hello all, a bit late, but if everyone did everything right every time, we would still have < 100 % safety rate. Having said that, I am not comfortable with the added guess work of not knowing whether or not those units of rbcs were taken out of the appropriate temperature/OR regfrig for who knows how long (ooops!!!) and then returned to Blood Bank, deemed ok. I am big on being a good steward of company's $$$, and unnecessary wastage makes my stomach hurt . However, the patient's safety is my ONLY concern here. Forgive me, but I do not see how the charts, monitors, and alarms can tell me the truth about whether those units spent their time in New Orleans in June or Chicago in.. well you get the point. At least the irreversible temperature indicators (firmly attached and not disturbed) give me some level of assurance. Any one with better/new process, please share. Happy Friday!!! No spell checks please . Connie

Thank you Terri, I have given up on my new facility. I am trying to narrow down to one problem (GAP) in the hospital transfusion service. The culture has changed so much in my 25 years in the business. In the past 7 years where I've worked, there were ongoing staffing problems in this critical department, as opposed to the general lab, so I am researching what others are doing to have a successful program of training and retaining competent technologists, and what I can do differently to achieve the same results. As you can probably detect, I am struggling. However, my focus keeps taking me back to this problem. Currently, this is a real problem for me in my new role, so a lit review will benefit me. Any input is appreciated. No spell checks please. The white wine and grapes are almost none. Regards, Connie

Wow! You all get to get Malcolm Needs live and direct? What about the West Coast?

$12,000?? where did this number come from?

Hi all, Terri, I am very familiar with GW as I am the last man (non-military) standing in the program, trying to finish my MSHS (Immunohematology). It was very intense but I enjoyed the instructors and the education. I challenged the boards, got my SBB, then I entered the program to pursue the M.S. I have relocated a few times, so it has really been a challenge. I need to come up with a research project to complete this degree. It has been a problem trying to get a local mentor (researcher, pathologist, etc.) to support me. This is the only part I was not happy with. My finishing has to do with whether or not someone will help me? I am in a new job now with no support. There was initial support for one project that did not get approval, for whatever reason. I would appreciate any help on choosing a new topic for research. Since I did not get approval to conduct a wet project, I can pretty much choose any problem (GAP) to research. I love all of Blood Banking. It is very hard to narrow down. You helped me pass the SBB, now I need you all to help complete this program. No spell checks please. Thanks for your time. HELP!!!!!

Hi Terri, just wondering. Do you still want a reply to this post? I am late, but can tell you about GW. Connie

When commenting in the patient's history, I write out Anti-little c. My middle name is "Preventive/Preventative".

Please provide additional information.

Thanks guys. Your support means everything. I accepted a Blood Bank manager position at a well-known hospital and University. I will continue seeking your support and guidance, as this forum is the great gift that keeps on giving. My 2015 pledge is to be more visible here instead of behind the scenes. I look forward to breaking the Christmas bulbs again. Please,Please bring them back Respectfully, Connie

Lab director. Medical director is not heavily involved on clinical side. I advised the seasoned blood bankers to make sure he knows it is unethical for lab director to require only 5% review when lab director knows there have been many near-misses and serious potential for harm to the patient. Thanks, Connie