tbostock

We had an OB nurse mislabel a specimen. We typed the patient as AB Pos and she was really O Pos. This happened just ONE MONTH after we implemented 2 blood types before giving type specific. So we caught the error when her second sample typed as O Pos. Thank God we did not give her blood, and if we did we would've at least given her O cells with our new policy. As it was a near miss though, we still reported it to NYS, quality, etc. The nurse acted like it was no big deal because "I must have just grabbed the wrong label".

Sadly, I think you will have to discard all of the products. They were well outside the minimum temperature for quite a while. And there needs to be corrective action for the tech involved as well as preventative action so this never happens again. Hide the key maybe?

We also do the @ cells on the Ortho panel and do not do AHG crossmatches.

Absolutely, a thousand times NO. You have the regs to back you up; see Dr. Pepper's post above. Crystal clear that it has to be labeled appropriately AT bedside.

I am seeing more of these types of citations when inspectors who worked in Chem and Hemo want to apply all of these regs to BB and Micro. Some of them should be, and some just don't make sense. As David stated above, we're not looking for BB QC results to fit into a narrow range of values, but do they work as expected or not. And they always do. Just like the correlation of methods: if you have 2 CBC anaylyzers, you need to correlate that the results from either analyzer are very close...makes perfect sense. Comparing tube testing with solid phase or gel is like apples and oranges; they don't always correlate so you're just proving what we already know...that if you have an Anti-K reacting 1+ in gel or solid phase, it will most likely be negative in tube testing.

All the studies so far show that liquid (never frozen)plasma is superior to thawed plasma up to the expiration date. I'm sure there will be further studies as interest is increasing. It does kind of make sense...would you rather eat a fresh steak or one that has been frozen for a year and thawed?

Correct. Also they each do NYS Dept of Health proficiency tests during the year which include all tests and methods, so those are all unknown. My inspector even wanted me to "grade" each one with 100% and my initials to prove that they passed.

Heard all about this at the AABB Annual Meeting last year. I want it! Actually it has always been licensed, the FDA never took it away. You just need to convince your Blood Supplier to make it for you.

I want liquid plasma SO BAD!!! I'm working with my blood supplier on this.

We don't do elutions here. What I do is watch them do one of each type of method. So I have them do a specimen on the Tango with every test ordered. Then a type (tube testing), antibody screen (gel testing), and Direct Coombs' (AHG procedure). The day shift techs also have RPRs and fetal bleed screens. While tests are running/incubating, we go through the policy review and scenario questions. I do like the scenario questions instead of a quiz because sometimes there are different paths to the correct answer and it gives us a chance to talk it out. Gets them thinking.

We have a microwave thawer; we like ours. Very fast.

Yes, we also have workarounds for the crossmatches. We run them on the Tango and print the results and have the tech manually enter the results. It happens so rarely it's not a big deal for us.

All techs who work in the BB, all shifts, need to come in on day shift and do a 3 hour competency session with me. Direct observation, a lot of review of procedures, panels "on paper" to assess their ruling out skills, and lots of scenario type questions ("what would you do if..."). It's painful, but our last inspector was pleased. And the techs actually said they liked it, that it was a good review...not sure if they will still feel that way after a few years of it in a row.

Do you have a quick way to thaw plasma? Early use of plasma in your MTP will improve outcomes. See attached for my MTP policy; it's probably more than what you need but use what's helpful. Massive Transfusion Protocol, Feb 2014 rev, 5-8.doc

I have the Tango, and yes, that is correct, since it only uses the DIN, it can't tell that they are two different units. So we have work-arounds for how to get the unit rechecks done. And yes, there is some manual entry involved. I don't think there is another way around this until BioRad figures this one out.

Normally I would recommend buying the printer and not trusting them to get the volume right (I know of a hospital that "accidentally" gave the child the whole unit and it led to a very bad outcome). But if you're talking about something that might happen once every few years and you don't have the ability to aliquot/label, you'll have to give the whole unit. I would just want to be VERY involved to make sure I verified the correct volume and ensure that the nurse knew exactly how much to give. Even if that meant being present for the transfusion...yeah, yeah, I know...not Blood Bank's job, but I also like to sleep at night.

Careful though, when there are documented studies that show that warming does diminish some clinically significant antibodies. Mallory, D: Controversies in transfusion medicine. Prewarmed tests: pro - why, when, and how - not if. Transfusion 1995 35: 268-270.Judd, WJ: Controversies in transfusion medicine. Prewarmed tests: con. Transfusion 1995 35: 271-275.

We do 6 months after they are deemed competent. Then again at their 1 year anniversary.

We have both in our BB, but in NYS we have to make sure we always have a technical supervisor (BS degree with at least 6 years experience) present wherever high complexity testing is happening. It's making hiring a little difficult.

We stock the 4-factor PCC (KCentra). Stops a brain hemorrhage much faster and with much less volume than multiple units of FFP. It may cost a bit more, but if it saves a brain... See attached for a journal article about it, and our Epic tip sheet that has indications, dosing, etc. CHEST journal article about use of Kcentra.pdf Kcentra Epic tip sheet.pdf

When we do our method comparisons we compare LISS tube testing, Peg tube testing, manual gel, and automated solid phase (Tango).

There is no regulation that requires this but we have always used 2 degrees for refrigerators and 5 for freezers.

Yes, data conversion is the way to go. We did that with SoftBank and it was excellent. But overall SoftBank is very flexible and you can add any antibodies, antigens, special requirements (irrad, CMV neg, etc), transfusion reaction history, and comments manually. You can also edit existing ones. There is a special message option of "note to tech" that we use quite frequently that we put detailed notes on a patient that are particular to their situation/history.

Correct; that's exactly how we handle it. Print the results and have a tech enter it. Our policy here for any result transcribed into the computer is to have a second tech (either simultaneously or immediately after result is filed) check the paper record against the result in the LIS for accuracy. The second tech has to initial the paper report as well.

Yes, the syringe should still be ISBT labeled. However if you do it that infrequently, I would just have the Medical Director sign for this as an exception to policy. That way his/her approval is documented in case something goes wrong (like at another hospital I know where the nurse tried to get the whole unit into the baby...yes, really).