Joanne P. Scannell

We used to use the >10oC limit but we got cited for that by the FDA a few years ago. As I stated earlier, they consider the blood on the floors 'in storage'. So now, we have to use the 6oC limit. Grrr.

We are using AlbaQ-Check and it states in the IFU (aka Package Insert) "Once opened, vials can be used for 7 days." IF there is such a restriction on the corQC, it would state it in the IFU. If not, then it should be good until the original expiration date. If it doesn't last that long, then that's a problem with the product and the manufacturer should address it.

Ditto! I took the exam in 1981 and it was essentially 'Trivia Pursuit' for Immunohematology ... and yes, it included a set of unknowns that were sent if the written portion was passed. Those were wild, crazy as well. For some reason, the requirements for 'passing the SBB Exam' have drastically changed. I've seen people study 'a book of questions' and pass the exam ... Just sayin' ...

Since all antibodies have a specificity, we don't use the old term 'non-specific'. If we don't know 'its name', we report one of the following as applies to the workup: Cold Antibody: Undetermined Specificity Cold Auto-Antibody: Undetermined Specificity Warm Auto-Antibody: Undetermined Specificity Antibody Detected: Too Weak to Identify at this Time Possible HLA/HTLA Antibodies Antibody Detected: No Identification at this Time

In the US, we use metrics in the lab - Celsius, grams, milliliters, centimeters, etc. The 'outside world' uses Fahrenheit, pounds, cups, feet, etc. ... even nurses and MDs! It would be nice to go metric 'out there', too!

Here in the US, according to the FDA CFR640.2c3, we cannot issue a unit that has not been maintained at required temperatures ... we can take it back, but we cannot issue it. Therefore, I believe it is a violation of this requirement to hold the unit in the BB and reissue it, even if it is for the same patient, even if it is within that 4 hour window. BTW: The 4 hour limit is for the completion of the transfusion, not the start of it. In addition, the FDA has told us during our most recent inspection that the CDC determined that once issued blood is delivered to the location, it is considered 'in storage', not 'in transport', therefore the 1-6oC temperature restriction applies. Given those restrictions, when an attempt is made to return blood to us and the unit temperature is greater than 6oC, we tell the infusionist to keep it and try to get the transfusion completed within 4 hours of the issue time or we will take it but will have to discard the unit. They usually opt to keep it ... and they usually get the transfusion accomplished in time. I see no value to re-entering the unit then reissuing it other than to create busy work for everyone, set yourself up for a citation (if you are in the US), and create confusion.

I agree ... this is extenuating circumstances and actually more efficient at getting blood products 'out the door' when 'multiple unknown recipients' are involved. I believe they used this approach during the Boston Marathon bombing but instead of 'just anyone' distributing the blood, they used a BB/Lab tech who knew the importance of keeping track of the units/recipients.

Whenever this subject comes up, I respond with 'Would you rather have the BB Techs running around the hallways or in the Blood Bank working on the case?' We do not deliver. Period. There are lots of people in this hospital who are trained to do that (like every ward has a handful, transportation department, etc.). If requested, we say 'call the nursing supervisor, he/she will make the necessary assignments.' PS. We do have a DumbWaiter that we use for the ORs (one floor above us).

Anything over 3 cells is a panel = bill for a panel.

Translate/Calculate them to 'panels' and bill 'per panel'.

Note that we are all ruling out with only 1 cell every time we interpret AS = Negative. If we had to use the 3+3 rule for that, Antibody Screens would have to contain a lot more cells. I see the 3+3 rule as applying to Antibody Identification, e.g. Don't call it an Anti-Cw unless you have 3 positives. Don't call it an Anti-Jsb unless you have 3 negatives. (Ruling out others, of course.)

Where can we get these red insulated pouches with the gel packs? I like this idea considering that we, too, have experienced 'over the temperature limit' units that have been issued in a ziplock bag then returned 10 minutes later. And I agree with some of these posts that ... a) The safest route is to take the temperature of the unit when it returns to determine acceptability regardless of how long it has been 'out'. Since there are regulations (at least here in the US) that state that if blood products are not under continuous temperature monitoring, the temperature needs to be recorded at least every 4 hours, then restrict the 'storage' time of these units 'outside the BB' to no greater than 4 hours (unless they are in one of those validated transportation boxes like the Red Cross has).

Cold Antibody: Anti-M? (Gel is notorious for picking up Anti-M due to it's acidy ... so don't expect duplication with tube.) And Anti-M is so persnickity ... reacts with homozygous-only sometimes, reactive cold-only sometimes, reactive warm sometimes ... and sometimes the screening cells are all M Positive ... temperature of the plasma/gel card/room at time of testing ... etc. We find 'a lot' of Anti-M's on our prenatals ... just a thought to chase down.

We DO use cord blood for pretransfusion testing but prefer a direct sample from the baby ... which is not what they want to do when a child actually needs a transfusion. All Cord Blood is specifically labeled according to our current pretransfusion sample criteria. It is a special blue top, non-vacutainer tube ... no confusion possible with maternal sample. We use gel testing. In gel, you can easily see dual populations ... as opposed to tube testing where 'mixed field' is difficult to detect. N.b. We were all taught many years ago that newborn ABO Typing is weaker than in adults. There's an Editor's note in an old Transfusion journal that describes that these 'weaker ABO Types' were most likely dual population (mom and baby). Wharton's jelly is not a problem. (I've actually heard that's an 'old wive's tale' from some people.) If there are antibodies in the Cord Sample from the mother, well, we actually DO want to see them. Note: We issue O negative RBCs (with other special requirements), so even if the Blood Type were in question, it is a mute/moot point for the transfusion.

I've seen them at 'The Container Store' ... USA.

I am, I imagine like you all, tired of the thousands of words written about this topic ... and we never come to a consensus, never a conclusion, and no one is changing the rules out there. Just putting this thought into the mix ... We are not supposed to use outdated blood products for transfusion for various reasons ... and we don't dispute that. So, if we need the extension, we freeze blood products (when applicable) to extend the shelf life ... 1 year for plasma/cryo, 10 years for frozen RBCs (correct me if I'm wrong about that). We are not supposed to use outdated reagents for another set of various reasons ... but there are times when we NEED to. Sooo, why aren't we pressuring the manufacturers to come out with some sort of 'freezing solution' for reagent RBCs? The stuff exists, it's just not simple enough ... we'd like something like 'wash a drop of the cells, add a drop of this, mix and freeze' = outdate extended.Seems to me such a solution is much simpler to accomplish than all these opinions crashing against a solid wall (=don't used outdated stuff). Is that too much to ask for?

It's just a worksheet that has columns for the 11 or 16 cells (depending on the panel) for rows and rows and rows ... this way, it's easy to see the results from the previous panel(s) for comparison. (ie. we are not recording the QC onto the antigrams supplied by the manufacturer).

This is precisely why instructions to check/test the father's RBCs is part of our Unicorn Tracking Protocol.

Ditto, ditto, ditto here. The reality is that the Rh is the only test result we NEED if Mom is Rh-neg. Of note, the Neonatologist at our hospital put in place a 'screening system' for determining which babies were jaundice. As you all know, babies come in many colors so visual determination is highly 'unscientific' so a bilirubin is performed after so many hours and if over a threshold, another is ordered for another so many hours. If this happens, they order the tests they need to help determine the cause of the elevated bilirubin (e.g. ABO/Rh/DAT). PS We perform ABO/Rh/DAT on all babies born of mothers who have clinically significant antibodies. This gives them a 'head start'.

Interesting, thanks! Somewhere there's an article that states that DVI is the 'weak D' that makes Anti-D, the other 'weak D' types don't.

YES! And again, with documentation of the check.

Precisely! Read, read, read the package insert and make your policies based on the facts. Not all Anti-D reagents are the same ... some detect weak D at IS, some after 37oC incubation, some require AHG Phase. Furthermore, some are designed to NOT detect DVI (e.g. MTS). 1. Does anyone know where the 'magic' number (grade 1+) came from? Do patients with less than 2+ reaction make Anti-D even though they have the D antigen on their cells? I suspect, like some of our 'old rules', there is nothing to support the statement ... especially knowing what we know now about making reagents and the D antigen. 2. Do ALL your techs perform tube testing to get the EXACT same results EVERY time? Wow! (Even the old titer QC allows a 1 tube deviation because humans are 'variable'.) We follow the package inserts: A positive result means the antigen is present = Rh Pos. (The Anti-D reagents we use do/don't detect DVI as appropriate for the reason for the testing, e.g. patients who are DVI, are to be classified as Rh Neg. So, we can tell the difference.

We also use BB Bands so we do not require a second specimen. We do require a second tech perform a recheck if there are no previous BB Banded specimen ABO/Rh on record. (Prenatal, hearsay, etc. doesn't count.). And ditto: No BB Band = No Transfusion. (Take it 'Uncrossmatched' until a valid specimen is drawn and all required testing is done.) Just because 2 specimens are the same blood type doesn't mean they came from the same patient. You still don't know if the first one was right ... or the second one. Well, that's what we tell Hemo when they come in asking us to type two specimens bearing the same name that fail delta check ... why do people think it is any different for Blood Bank?

Ditto. Perhaps the logical solution to the problem of 'not wanting to redraw a neonate' is to restrict neonates to Group O. That follows the policy actually ... 'Give Group O until a second sample ... blah, blah, blah.' Love the 'Bombay' comment, btw ...

No diluting for Tube Testing. BUT we do have to dilute the Confidence Antisera for manual MTS testing otherwise the result is 4+ which is useless. At this time, we add 1mL Confidence Antisera to 9mL 6% Albumin (I prefer that to saline, but perhaps saline would work). This dilution produces a 2-3+ result in MTS. I must add that I am in the process of decreasing this so that we get 1+ results in response to a lot of chatter out there about 'testing vs a weak antibody' (CAP)... I don't see 2-3+ as 'weak'. So, this dilution will be changing. But it's a start ...