hati

Hi, I work at a small hospital. Being in a small lab, we have to deal with outpatients on weekends. It is hard enough to deal with ER pts and we have to deal with Outpatients. I have no phlebotomist on Sunday. My question is, how do we get away from this 72 hrs period blood bank samples for Preop.Usually , they come for certain tests but they have to come back for the type and screen before the surgery. There is so much emphasis on customer service. There should be a way that our Type and Screen results will still be good for certain days. Thanks .

SUBJECT: Blood Bank Mini Cold/Pre-warm Technique NO: 707-0116 Policy Procedure Protocol/Pre-Printed Order Other: Effective Date 12/08/2009 Date of Electronic Distribution 12/09/2009 Dept. Manager Medical Director/ CAH Oversight Administrative Policy Committee Committee Other Audit Review: Initials: Date: PRINCIPLE: The tube method includes an immediate spin phase that detects antibodies at room temperature. Most saline reactive antibodies are considered clinically insignificant antibodies. A mini cold panel can be performed when positive reactions are observed in the immediate spin phase with weaker reactions observed at 37C and negative anti-human globulin (AHG) reactions. If the mini cold panel confirms the presence of a cold antibody, the pre warm technique can be performed. The Pre-warm technique may be useful to minimize or reduce cold reactive auto- antibodies interfering with the testing phase reading. This test is particularly useful for testing sera of patients with these cold-reactive antibodies (cold agglutinins) that may mask the simultaneous presence of clinically significant antibodies. The technique should be used with caution since it may decrease reactivity of some potentially significant antibodies and weak antibodies can be missed. SPECIMEN: Fresh plasma (EDTA specimen) that complies with pretransfusion specimen requirements (≤72Hrs old) REAGENTS, SUPPLIES AND EQUIPMENT: Test Tube Rack 37o C Heating Block 12 X 75-mm Test Tubes Disposable Plastic Pipettes Centrifuge Pre-warmed (37o C) Saline in Dispenser Bottle Panoscreen III Cell Screen Check Cells Donor Units 4°C Refrigerator or 4°C slush bath four tubes as MINI COLD PROCEDURE: 1. Set up and label follows: Auto Control (patient cells with patient plasma) and screen cells I, II, and III. 2. To each of the above tubes, add 2 drops of patient’s plasma and 1 drop of the appropriate red cells. 3. Gently mix tubes and place in the 4°C Blood Bank refrigerator for 15 minutes. 4. After the 4° C incubation, centrifuge tubes for the calibrated spin time. 5. Do not read the tubes immediately, but gently replace the tubes back into 4°C refrigerator for 5 additional minutes. 6. Read and record reactions on the Blood Bank log. Interpretation of results: If the reactions read 1+ or greater, the antibody can be determined to be a cold and the Technologist can proceed to the pre warm technique. PRE WARM PROCEDURE: If the presence of a cold antibody has been determined follow the instructions below: 1. Pre-warm a bottle of saline to 37o C. Place the bottle in the micro incubator for 1 hour. 2. Label one 12x75 tube for each reagent or donor sample to be tested in accordance with test requirements (crossmatch, antibody screen, reverse group, etc.). 3. Add one drop of 2-5% suspension of red blood cells to each appropriately labeled tube. 4. Place the tubes into the 37o C heat block and incubate for 5-10 minutes. This includes a tube containing a volume of the patient’s plasma adequate for performing all the necessary testing, 5. Transfer 2 drops of the prewarmed plasma into each tube containing prewarmed red blood cells. Mix tubes without removing the tubes from the heat block. 6. Incubate at 37o C for 30 - 60 minutes. Also warm an aliquot of IgG anti human globulin in a tube in the heat block. 7. Remove tubes from the incubator and quickly fill each one with prewarmed saline. Wash the cells 4 times by hand (do not use cell washer). Blot extra saline from each tube after the last wash. 8. Add two drops of pre-warmed anti-human globulin (IgG Coombs) to each tube and centrifuge for the calibrated spin time. Examine for agglutination using the magnifier viewer. Record your reactions. 9. Add one drop of Check cells to each negative tube and centrifuge for the calibrated spin time. Examine for agglutination. Failure to show any agglutination in this phase of testing is to be regarded as a QC failure, and the test must be repeated. 10. Discard the warm saline and wash the saline bottle thoroughly before filling with saline to avoid bacterial growth. REPORTING RESULTS: 1. If the Pre-warmed technique elicits a negative result, report as follows: “Probable cold antibody, clinically insignificant”. Additional referral testing performed upon physician request. 2. Blood warmers are not routinely used unless there is a potent cold antibody (3+ or greater reaction.) NECESSITY OF CROSSMATCHED UNITS: In the event a crossmatch is ordered for a patient with a cold antibody, a full AHG crossmatch using the pre-warm technique needs to be performed. PROCEDURE NOTE: Immediate spin and 37 C are not part of pre-warm technique. This procedure will not detect alloantibodies that agglutinate at 37o C or lower and are not reactive in the antiglobulin phase. REFERENCE: Local policy American Association of Blood Banks Technical Manual Current Edition and 8th edition.

We do a mini cold first , if it turns out to be positive,that's the only time we proceed to prewarm technique.

Dear Brenda, Can you please send me a copy of yur checklst , my email is hatibote@yahoo.com.Thanks!

Hello there, I am a little bit confused. Do I have to do check cells on a +/= reaction. Here are the results? Currently , we are just using LISS and 3 screen cells. On the screen cells 1, I got 2+ on both IS and 37, but a +/= on AHG. Here are the breakdown. IS 37 AHG CC Screen cell 1 2+ 2+ +/= Screen cell 2 0 0 0 2+ Screen cell 3 2+ 1+ 1+ We sent the sample to ARC for a workup since this is a small lab. Thanks for the input:)