jayinsat

I agree with Malcolm. I would dig as deep as possible to find that antibody history. If none can be found, I would do AHG crossmatches. If it was a frequent antibody, the titers should rise to detectable levels soon.

You did everything that was required in this situation. The patient was a trauma and needed emergency transfusion. The risk of death outweighed the risk of a hemolytic transfusion reaction in that scenario, according to the treating physician. I once had a trauma surgeon tell me "I can treat a transfusion reaction but I can't treat death!" That put things in perspective for me. That is why thy sign the consent.
Next step would be to report this to your risk management department so that follow-up can be made, including monitoring the patient for the s/s of DTR. 

All, I am about to blow your mind....
Our plasma freezer is down and so is our backup. The freezer will not get colder than -18 C. I was preparing to move all the products into boxes with dry ice until I had a conversation with my 87 year old dad, a retired blood banker from University of Chicago. He said to me, do not take the plasma out of the freezer and put it in boxes, PUT THE DRY ICE IN THE FREEZER, IT IS THE BEST STORAGE BOX YOU HAVE!!!!
MIND=BLOWN!!!!
I did that. Our freezer is currently reading -25.1C and getting colder. Furthermore, the probes in the freezer continually monitor the temp in the freezer so you don't have to record temps every 4 hours, the chart is doing that for you!!!
Isn't that cool? That perfectly illustrates the difference between wisdom and knowledge there. I wish we could hire my dad.
I just had to share this here.
PS. Freezer is now at -26.4C.
 

ISBT has an excellent podcast I have been listening too. You can listen and subscribe here:https://www.isbtweb.org/resource/announcing-our-new-podcast-transfusion-practitioners-across-the-world.html 

ISBT has an excellent podcast I have been listening too. You can listen and subscribe here:https://www.isbtweb.org/resource/announcing-our-new-podcast-transfusion-practitioners-across-the-world.html 

I would thoroughly recommend that you contact Rachel Moss Hibbttt at Imperial College Healthcare NHS Trust.

We issue uncrossmatched units in our BBIS, so it prints tags for the units that resemble those for crossmatched units. Fast, easy and accurate plus the RNs can scan the units in Epic to document transfusion.  We use SafeTraceTx.  We have a downtime uncrossmatched blood form we can complete on paper.  We keep a photocopy.  See attached.
Emergency Release of Blood Products (form) (20553_0).pdf

Bet they will sooner than later as more antigen typing is automated. I was delighted when the DAT survey for automation came out, even if it is ungraded for now.

Our window opens in October. I will not budge! If our inspector gives a deficiency for this item I will take my fight to CAP. If I do not win, then I will make the change. I am hoping by then they get their collective heads out of their posterior waste removal orifices and accept the rational and logical process.

Our window opens in October. I will not budge! If our inspector gives a deficiency for this item I will take my fight to CAP. If I do not win, then I will make the change. I am hoping by then they get their collective heads out of their posterior waste removal orifices and accept the rational and logical process.

Our window opens in October. I will not budge! If our inspector gives a deficiency for this item I will take my fight to CAP. If I do not win, then I will make the change. I am hoping by then they get their collective heads out of their posterior waste removal orifices and accept the rational and logical process.

Our window opens in October. I will not budge! If our inspector gives a deficiency for this item I will take my fight to CAP. If I do not win, then I will make the change. I am hoping by then they get their collective heads out of their posterior waste removal orifices and accept the rational and logical process.

Our window opens in October. I will not budge! If our inspector gives a deficiency for this item I will take my fight to CAP. If I do not win, then I will make the change. I am hoping by then they get their collective heads out of their posterior waste removal orifices and accept the rational and logical process.

Job security??? My comment about several of the All Common checklist items is "we ain't chemistry!". Not that it gets me anywhere.
Since we are in our inspection window, I made emergency changes to my SOP/form for that and we will scramble for suitable specimens.   Our problem is finding enough suitable antibodies with sufficient sample volume to do all this extra testing. As part of our Patient Blood Management program we draw minimal patient specimens - just enough to do the ABS and an antibody ID if it isn't a warm auto workup. We can squeak extra antibody screens out if the patients Hgb is low enough, but not multiple ID panels. My only solution to that is to do abbreviated panels using 3 Ag positive cells and 3 Ag negative cells, then state that the results are consistent with the antibody IDed with solid phase. If that's not good enough - (bad words). 

QUITE RIGHT TOO!

I'm annoyed! Yes, there are differences in results between automation, GEL and tube testing. Automation is the most sensitive and tube testing is the least sensitive (but the BB gold standard method), with GEL in-between. I wrote that bit of information in my procedure so an inspector would know I am aware of the possible differences.   We are doing this exercise to make sure the methods compare, if the specimen is positive in automation, it should also be positive in GEL and tube testing and should appear to be the same antibody on the antigrams. If I am doing an antibody screen and an AB ID, I am using the same METHOD whether I am testing using 3 screening cells or a panel of 10 or more cells. 
Yes, we have the rare antibody screen that gives wonky results in automation and and is stronger in GEL. That tells me we need to do the ID in GEL so we can actually get an answer we trust. Different antibodies work differently in different methods but the screen and AB ID should be the same within the same method. Our screening cell method in tube is the exact same method as our panel tube testing. If I am doing the comparability testing, I am using a strong antibody that has a 3-4+ result so I can be assured I will get similar results across all 3 methods. I'm not going to use a weak or wonky antibody that would give shady results an inspector could question when they view my forms at an inspection.
This is Method Comparability, not Test Result Comparability. Does CAP have to have a quota of standard changes they have to meet? I'm on a soap box and I am sorry to rant but this seems unnecessary and extra work for the same AB screen results across the different methods. 

So, this PROVES that CAP do not know the A from their elbow.
ALL Blood Transfusion Reference Laboratory Staff, not to mention MOST Blood Transfusion Hospital Laboratory Staff KNOW that not all antibodies can, by any means, be detected by ALL serological techniques (saline, albumin, enzyme, LISS, IAT, inhibition tests, recombinant blood group proteins, etc), let alone by ALL technologies (glass, tube, plastic tube, liquid phase microtitre plates, solid phase microtitre plates, column technologies, etc), BUT THOSE WHO RUN CAP KNOW BETTER THAN EVERYONE.

They should be thoroughly ashamed of themselves, and go back to kindergarten.

I don't have a "procedure". We just make a dilution, then do the test. If the reaction is too strong, we dilute it some more & recheck (or add more antibody if it's too weak, etc.) and just repeat the adjusting and testing until we are satisfied with a 1+ reaction.
Donna

Unfortunately, I don't have another supervisor, asst manager, or even a lead tech who can perform my competency.  And the only 2 techs who have bachelor's degrees work mainly in Micro, so they're not strong blood bankers.  But, according to CLIA, they're qualified to perform competency assessments in blood bank.  I think a lot of times these regulations look good on paper, but they don't always carry over to real world situations.  That's how people end up in supervisory positions when they have no idea how to actually do the job themselves.  There just aren't enough people who meet all of the regulatory requirements and have the knowledge and experience to do the job effectively.

Our director completes an assessment for the supervisors each year, which states that we are competent to perform our supervisory duties, one of which is assessing the competency of our staff.  That was not sufficient for CAP, though, to show that I am competent to work the bench.  I understand their argument, because I have worked with managers in the past who were not capable of working the bench.  But, then those managers were not qualified to assess the competency of their staff, in my opinion.  
In response to the CAP deficiency, I had one of my techs sign me off using the same competency form I use for the rest of the techs.  The issue I have now, though, is that only 2 of the techs trained in our blood bank have bachelor's degrees, and they are not my strongest techs.  The best techs I have in my department only have associate's degrees, so they're not qualified per CLIA regulations to perform competency assessments, even though they have over 20 years of experience.  But, that's a whole different topic of discussion.

I also fill in on the bench and do the same competencies that my team does. On a slightly different note, CAP cited us recently for not having the person assessing competency evaluated for their ability to assess competency (I think that makes sense).  So now we have a document stating that the person assessing competency has been reviewed as able to assess competency (team member levels and managers)

During a recent CAP inspection, my facility was cited for not having an annual competency assessment performed for the Blood Bank supervisor (me).  Our lab director completes an assessment each year stating that each supervisor is competent to oversee their respective department(s) and listing specific supervisory tasks that are assessed.  Shouldn't this supervisor assessment also be sufficient to verify that I am competent to perform testing in the Blood Bank?  It seems a bit silly to me that I am deemed competent to assess the competency of the rest of my staff, but I'm not competent to perform the same tasks myself.  I must have one of my staff observe me performing critical tasks, only to turn around and complete that person's direct observation myself.   I'm also the one who writes and grades the competency exams each year, but am I also expected to take the test myself?  Please let me know your thoughts on the subject.  Thanks.

I agree with Malcolm. I would dig as deep as possible to find that antibody history. If none can be found, I would do AHG crossmatches. If it was a frequent antibody, the titers should rise to detectable levels soon.

I worked at a site that sent cards. Never did any good. For all the work there was no benefit. As for the chip...pass.

I worked at a site that sent cards. Never did any good. For all the work there was no benefit. As for the chip...pass.