tbostock

Go with your gut instinct and discard them. They are probably fine because the chart looks good, but I'm a big fan for being better safe than sorry. The refrigerator is hooked up to some type of remote alarm if it goes out of range, correct?

Yes, this does require FDA registration. Preparing syringes/aliquots for babies does NOT require it, but preparing units for exchange transfusion DOES.

You can find the list on the ICCBBA website: https://iccbba.org/tech-library/iccbba-documents/databases-and-reference-tables/product-description-codes-database2

I think Goodchild's post did not show the entire list of people qualified to be technical supervisor; for CLIA it states that a bachelor's is also acceptable for a Technical Specialist: Bachelors in medical technology, chemical, physical, or biological science AND 4 years training/experience in high complexity testing in the respective specialty It's not that you can't have MLTs in the Blood Bank at all, but you have to prove that 24/7, 365 days a year, you have to also have someone qualified as a Technical Supervisor there at all times to directly observe the MLTs. It can't just be a supervisor in another dept if they don't know Blood Bank. This person can also help the department supervisor do some of the more higher level reviews, such as QC review, reviewing antibody ID workups, reviewing exceptions, etc, but only if they also qualify by NYSDOH's standards for a supervisor, which is 6 years working as a licensed technologist.

Sounds like you made really good decisions but I agree with a couple things the other folks above talk about: 1. As a new BB tech, you'll need more backup and support. 2. Keep learning; knowing that Anti-M is usually not a big deal could have been a little calming for you. 3. When someone is truly exsanguinating, you can safely ignore antibodies until they stop bleeding. As they say "incompatible blood can be fatal, but death is always fatal". If you never have knots in your stomach again, you may not be a good Blood Banker. We will never be perfect, and it's the adrenaline rush that you get with cases like this that keep you learning and also remembering why you work in this crazy field. Not too many people get to go home and say "I helped to save someone's life today".

Check out the attached; this is why we don't use the term least incompatible anymore. It gives a physician a false sense of security, and studies have not shown a correlation for the strength of the incompatibility in vitro compared to potential risk in vivo. It's an outdated term that we should all start moving away from. Least incompatible.pdf

Currently we have both MLTs and MTs in the Blood Bank but we are transitioning to MTs due to changes in NYS licensure concerning the CLIA need for technical supervisors in high complexity testing areas (like BB).

Yes, keep BioRad in mind. I saw their new gel workstations at AABB last year, very impressive. I have the Tango, which is solid phase, but is larger than the Provue.

John makes a good point above, that if you are going to do QC, then you need to make sure each panel cell is testing with both a positive and a negative at least. For example if you are using a diluted Anti-c as your QC material, you are only proving that the panel can detect Anti-c. Any antigens that are only on the c negative cells on that panel are not being tested at all. In the true sense of QC, you're not just making sure some of it works, you should have to prove that it can identify each antibody. Which is just crazy talk.

I once had a patient that received 2 units of blood and a month later came back with 8 alloantibodies. Insisted she was never transfused elsewhere.

QC for panels is not required by any regulatory agency. And I hope they never change their mind.

Worst thing is answering the phone "Blood Bank" when you're home.

Check your regs for record retention according to AABB, CAP, etc. In NY State, we would have to keep them for 10 years.

Same here

Welcome. I'm sure you'll love it here as much as we all do.

I still hold that the BB should be involved for checks and balances. Preventing one baby from being affected by Anti-D would make it worth it.

Warm auto antibodies, when starting out, can mimic Rh autoantibodies. Usually when they come back a week or so later, all cells including the auto are strongly positive.

Yes, sadly, we are responsible for anything nurses do involving blood transfusions. I asked about what they used for annual nursing competency for transfusion and was horrified at the content and rewrote it for them. There was a lot of outdated info and some that was just plain wrong. You want to make sure it has updated information in it (such as TRALI).

There is no 30 minute rule. You have to accept returned products based on valid temperatures instead of time, unless you have validated a specific time. For example, some BBs have validated it themselves and found that after 10 minutes, it's out of range. It's way out of range by 30 minutes, so you may want to re-evaluate your process. As far as FFP, since it goes out warmer than red cells, you can almost never get them to be in range for return. Platelets, as long as they are 20-24 and you do a visual inspection, you could have it in your policy to return them according to certain criteria.

We don't allow transfusing in ambulances because there is no nurse present. The helicopter we do because a nurse is on the team. In my state (NY) they are just starting to allow EMTs and paramedics to be able to transfuse but there are many questions about training and competency....who does it, who maintains the records, etc. So we are still allowing nurses only for now.

Good question; I would think you might have to register with the FDA if you are supplying units to an EMS provider for patient transport.

No we use the same reagents for the rechecks as the original; it's not a regulation to do otherwise.

I did a full validation when I received the refrigerators to prove that the electronic checks were accurate and have not had to do the ice/water since. We would certainly do it if there were any issues at all. But we also have wireless temperature monitoring with helps a lot. The reports show whenever there was an alarm activation and what the corrective action was.

Very tricky to do because of the alarm thresholds that we have set in our electronic monitoring system. So if we have it set to only alarm if there are 2 temperatures out within 5 minutes for example, then you have to allow your equipment to be out for that long to test it. Since this could compromise your products, you might have to move them to do the testing. Some respond very quickly, and we have a corresponding "spike" on the graph electronically, some are much slower to respond, so we're still trying to figure out how to do this safely.

I know right???!!! Now we can feed our addiction again.