tbostock

No. You have to give cells compatible for both. So give type O red cells. And type A or AB plasma.

1. He does both. 2. Mostly anatomic. 3. No. We don't have any pathologist that did a fellowship in Tx. Medicine. So the Medical Director attends Tx Committee, signs recalls, policies, etc, but not much else. I am his designee to do the rest. 4. 383 5. About 300 red cell tx per month.

I was wondering why the panel was done if the screen is negative; now I get it, if someone is trying to get a jump on the workup by doing both at the same time. So yes, you would want to do more investigation to see what is reacting. On a patient with known antibodies and we are now getting a negative screen, if we perform AHG crossmatches and get a rare incompatible crossmatch, we would probably investigate a positive DAT on the unit and/or seeing if the patient has now developed an antibody to a low incidence antigen.

A national registry would be a good idea and a good start. I would be concerned though about the quality of the information entered. Can any Blood Bank enter antibodies, or should it only be IRLs? Bad information may be just as damaging as no information at all.

I agree that we should head this way, and obviously OB/Gyn physicians need more education on this issue. Most of them use other laboratories for their prenatal testing, and then when the patients arrive here to deliver, we get different results from the other Laboratory and then we are recommending RhIg based on weak D results (or not, based on our results with our methodology) and it is not taken very well. I think the problem for us is that we do not have molecular testing available, so we send our samples out to the reference lab for Rh genotype testing. The results do not come back for 72 hours, so we are still giving the RhIg as the results are still pending. It will help for future pregnancies though, as long as the mom comes back to this hospital.

Yes, I inquired at AABB why they specified 2+ at immediate spin when so many of us are not doing tube testing anymore. No answer.

We use our saline cubes for one month: we write the date opened and the "opened" expiration date on the cube. We change our saline in our bottles daily, and clean them weekly with isopropyl alcohol, rinsing profusely with saline before refilling. Keeps the cooties at bay. Our bottles are all labeled "saline changed daily" and we have daily and weekly checklists where the tech documents that it was performed.

Not really an introduction, but I do have new letters at the end of my name: SBB I PASSED!!!!

Usually they just recommend a percentage, but I like your idea better of "picking your battles" by targeting ones that have a higher likelihood of being unnecessary transfusions. Because that's the area that you want to make an impact on. Picking a random percentage and then having to look at a 1 unit red cell transfusion for a 4 Hgb seems to be a waste of time.

Great idea Mari. We had to do this in the OR once; it was easier to just send the Blood Banker up there with a pile of blood to hand out.

I agree with David; see what your HIS can give you as far as reports. With the volume you have it is a very difficult process to do manually.

LOL...let's start a crowdfunding campaign for Malcolm. I'll pick up his drink tab.

Welcome!

We also used to review each paper blood admin record but now that we are going electonic (blood admin done in our EMR), I have to figure out how to get reports sent to me so I can review compliance with documentation. Some reports I want to get: 1. barcode overriding 2. transfusions with no end time 3. transfusions missing blood warmer info 4. transfusions over 4 hours We'll see if I can get them. We'll also be doing a lot of audits for the first month or two for compliance.

No, there is no reg where it says it has to be on paper. We are moving our entire blood administration process to the EMR. Everything will be documented in our HIS directly by nursing.

OK, someone has to get this topic going....so who is going this year?

When I looked this up, it said this is for Plasma, cryo reduced.

Yes, I have also started using it; unfortunately the only indication is emergency use (for initial emergency release or for the first two units for an MTP). There are studies that show that on day 15, about 50% of the clotting factors are diminished so you should not be using this for your routine plasma orders for patients who need correction of clotting factor deficiencies (including Warfarin use). It's wonderful for MTPs though. The docs love that we bring it right away. Then we start thawing FFP for the rest of the MTP.

Yes, I have also started using it; unfortunately the only indication is emergency use (for initial emergency release or for the first two units for an MTP). There are studies that show that on day 15, about 50% of the clotting factors are diminished so you should not be using this for your routine plasma orders for patients who need correction of clotting factor deficiencies (including Warfarin use). It's wonderful for MTPs though. The docs love that we bring it right away. Then we start thawing FFP for the rest of the MTP.

Yes, as Anna says, this is not anything we haven't known already. An antigen phenotype is not accurate if the patient has been transfused in the last 3 months. Very easy for us to see on our automated method; the results are mixed field.

Yes, it is the quickest and as far as I know Tropitronics is the only vendor in the US.

Yes, I heard about that hero. Amazing story. Great job Mari!

The label vendor was able to provide me with a document that they were approved for blood bags, but I never saw an SDS or anything, or even a mention of a specific type of adhesive that is approved. I would also like more info on this.

LOL you must have the same inspector we just had. We had the test results (yes, we result the clerical, DAT, etc) and the pathologist's interpretation but it was not electronically attested by him.

Debbie, I really like your plan. So when you thaw your 2 type A and 1 type B, do you extend them to thawed plasma (5 day outdate)?