bb4me

On and off, about 15 years. It took me a couple of years to become more "comfortable" in all areas of the lab, in that I felt that my judgement improved to the point where I felt more confident that I probably wouldn't harm a patient from either overconfidence or "analysis paralysis". At times, Blood Banking may seem a little more dramatic thank some other areas of the lab, but one of the key points I try to make with students/trainees is this: Blood Banking calls on the same skill sets that you use in the rest of the lab. If you can multitask, keep cool under pressure, understand your limits, and recongize that little bell that rings in your head that says "Wasn't there something odd about (insert situation here) that I learned in school/read about in a journal/saw on a similar case once?", you'll do fine in Blood Bank, and welcome! (Of course, it helps to love Blood Banking too!)

Thanks, Malcom. Yes, the "glass factor" was always my favorite. We also recognize that a positive C3b/C3d result from a refrigerated serum spec might be questionable, and recommend retesting using an EDTA sample, especially in the absence of historical results. That being said, we rarely see serum samples in our Transfusion Service any more.

Thanks, Goodchild. We have multiple methods (gel and tube), so I will be sure to consult all applicable inserts.

When evaluating a specimen for DAT testing, our practise has been to accept a specimen up to 24 hours old, refrigerated if not tested within a couple of hours of collection is preferred. Some of us have been taught that older specs may yield a false positive or a false negative; others just a false positive. We would like to clarify our procedure. I would appreciate any guidance on specimen age and impact on DAT results. What is your practise? Can you point me to any references? Thanks!

CAP has cited us for not doing daily negative controls on anti-A and anti-B, but (curiously) not with anti-A,B - same antisera manufacturer, same package insert. We have decided to institute daily testing of all 3 reagent antisera, since reconfiguring the computer QC worksheet is so labor-intensive, we don't want to do this again soon! CAP has confirmed that using an in-house 3% preparation of group O cells would be acceptable. Does anyone else use patient cells to test their commercial reagent antisera, and if so, would you be willing to share your recipe? I would be grateful for guidance on additives and outdate/frequency of preparation.

LOL Thanks for that, Rashmi!

We have been using the ProVue for more than a year, and are now trying to validate the interface. We have run into a serious problem when trying to send results from the PV to HCLL when a patient has multiple Accession numbers pending. For example, Oncology will often order Type and Screens q3 days (in order to keep a patient crossmatch-eligible at all times), and there may be more than one set pending for a single patient on our Active Test screen at a given time. We have seen the PV send the results to the wrong Accession number. (When a future Accession number is wrongly resulted, that future order will be satisfied, and phlebotomy will not be signaled to draw the patient, which will leave the patient "bare".) Our HCLL consultant has told us that since our Accession numbers differ from our Specimen numbers, there is no way for HCLL to address this. Has anyone else seen this problem? Any ideas?

We will call other facilities on occasion, when we have a difficult case and the patient tells us of prior transfusions. Likewise, we respond freely when other transfusion services call us with similar requests. I am glad to see this topic brought up. I have often wondered about this practise, and how in this day of patient confidentiality, we are so "casual" about exchanging information. We joke sometimes about a "bloodbanker's secret handshake" that would identify us over the phone to other bloodbankers. Any suggetions for passwords, challenge questions, or the like? :cool:

Did the patient receive any group A PRBCs prior to having been switched to Group O? If so, and if you elute anti-A, you might want to check to see if the patient is a subgroup of A before considering switching back to A cells.

I love this! In this economic climate, we are all being asked to do more with less and curb expenditures wherever possible, but your assistant lab manager is really thinking outside the box - and the workstations, and servers, and LIS support team cubicles....

At our institution, we must issue blood as "uncrossmatched" until a valid ABO/Rh has been recorded (i.e., all discrepancies resolved.) In a case such as this, I think that we would probably get the medical director's approval to issue group A, uncrossmatched (as opposed to group O), until the molecular results had come back. I'm curious - what would other labs do in the interim? Thanks, Julie

Our facility will issue multiple components at the same time to certain areas (OR, ICU, ED) as appropropriate, although sometimes a quick phone call to confirm a multiple issue is appropriate. We discourage multiple component issues to the floors. One very important caution is that although we will issue components for multiple patients to a given location within a close period of time, we NEVER combine multiple patients in one issue (for example, sending a unit of packed cells for patient A and another unit for patient B in the same pnematic tube carrier.)

Merry Christmas to my fellow blood bankers. And to all of those who have the holiday shift this year, special warm wishes - I'll lift in glass in your honor this year, if you'll remember me on New Year's Day! All the best, Julie H.