butlermom

Vis-a vis Sc:-3 blood, I remember when I was working as a VERY junior member of staff in the IBGRL Red Cell Reference Laboratory of Dr Carolyn Giles and Joyce Poole, we did a family study following the relatives of an Sc:-3 female in a small village in Papua New Guinea (PNG), and we found six others.  This was at least 40 years ago now, but it may be worthwhile contacting the PNG Blood Service to see if any of them are still donors, or, indeed, if they have found any other such donors.

Good tip!  We use temp indicators on the units, so that when they are returned, we can see if the unit was out of temp at any point.  We also asked them to provide a packing slip attesting to the proper storage of the units, similar to a transfer form used by our blood suppliers.  

If you will be getting any of those units back then a FDA inspector may want to see their storage records.  Some will, some won't, depends on the inspector.  Better to be prepared for the one that wants to see them.  In this case a little paranoia may be a good thing.

I could be wrong on this.....but I don't think the FDA would go to the other facility..........  We have several "sister facilities" that we send blood to for storage that are in our system and another facility that is not in our system.  When we get inspected, they don't go there.....  We are FDA registered because we irradiate and wash/deglycerolize units....ie - "create" products.  I think they just have to comply with CAP and or AABB standards for storage.

Agreed, we also supply blood to a facility outside our system, and the FDA inspector did not visit their facility.

My manager and myself (asst manager) both complete the same competency that the staff do in order to be able to be able to fill in at the bench if the need arises.  "This year's" competency is "good" for next year's observations.  It's hard to get done - but, we both feel it's valuable - and the staff seems to appreciate that we remain "competent" since previous management had no clue what went on at the bench....
Keeps us in the loop.

Sorry, I know this question is 3 years old, but I found this link from Fisher, it lists incubators that can go up to 150C if needed. Good luck
 
https://www.fishersci.com/us/en/browse/90088096/dry-block-incubators
 
 

I get what you're saying, but remember, with the antibody screen and panel you are using sensitive methods to detect the presence (and i.d.) of a clinically significant antibody. The titer is merely measuring the "concentration," if you will, of the antibody in solution. They are really two unrelated attributes. We use gel method for screens and i.d., but perform the tube method titer in saline using the CAP recommended Uniform Method. 

I get what you're saying, but remember, with the antibody screen and panel you are using sensitive methods to detect the presence (and i.d.) of a clinically significant antibody. The titer is merely measuring the "concentration," if you will, of the antibody in solution. They are really two unrelated attributes. We use gel method for screens and i.d., but perform the tube method titer in saline using the CAP recommended Uniform Method. 

I get what you're saying, but remember, with the antibody screen and panel you are using sensitive methods to detect the presence (and i.d.) of a clinically significant antibody. The titer is merely measuring the "concentration," if you will, of the antibody in solution. They are really two unrelated attributes. We use gel method for screens and i.d., but perform the tube method titer in saline using the CAP recommended Uniform Method. 

I would not be performing one hour post-transfusion vital signs unless the patient has signs or symptoms that require assessment.  I would not be reacting to one hour post-transfusion data unless they were consonant with a transfusion reaction.  If fever was the only sign or symptom, it's probably not transfusion related in the vast majority of cases.  Routine vital signs in the absence of a clinical rationale are a problem, not a solution.

If the supplier is the one we use and the product is packed appropriately we bring it into the inventory, notify the sending facility and notify the blood supplier.
If the blood comes from the other supplier which we don't have a contract with we notify the sending facility that we don't bring this supplier into our inventory and asked them what they want to do. Either we can send it back to them at their cost or if our couriers go to their facility we can send the product back to them . Of they can asked the blood supplier if they want it back (sometime they do as we share a parking lot with them). 
Don't ask why we don't use the blood supplier we share a parking lot with.  Long  sad story. 

If it is from the same supplier we use and packed appropriately, I have no problem accepting the blood into our inventory.  I contact the transferring facility for a transfer form if they did not pack one.  

Personally, I never had a problem receiving in blood like you described as long as it met all the requirements that we required from out supplier.  On the other hand I knew facilities that would discard any and all blood that was received from outside with out any thought.  I considered this a dreadful waste of a precious resource!   Just curious but did the blood have any of the temperature monitors attached to the units?  If so, that could help you make the decision.  
Having said all that, I have been out of the world for a while and many things have changed since I was intimately involved in the art of transfusion medicine so there may be some new regulations that can provide guidance for this well beyond my opinions.  I look forward to read what others have to say on the subject. 

We supply blood to a helicopter service with a contract with our hospital system.  We put Safe-T-Vue indicators on all of their units.  They provide us a copy of their in-flight chart when they transfuse anyone not coming to our hospitals.  If the patient doesn't come to us but has an account in our HIS, we create a bogus registration in our BBIS using a defined format account number.  If they don't exist in our HIS, we create a complete registration manually in our BBIS using a defined format for MR# etc.  Then we emergency issue the product in our BBIS and handle it just as we would those patients who expire before a specimen is drawn etc.  We charge the helicopter service for the products which they include in their flat fee to the patient.  We maintain the final disposition records for any lookbacks etc.  If we got a market withdrawal or lookback, we would notify the helicopter company to follow up with the recipient.  That duty is at least vaguely covered in our agreement with them, I believe.  We tell the helicopter crew to return any unused products to us and not to leave them at the receiving hospital but this isn't perfect.  We sometimes transfer products on paper to the receiving site if we can document handling sufficiently. It doesn't work easily if the receiving hospital doesn't use the same blood supplier.

We do the same for our traumas.  I think its a common practice.
Scott

We give O= unxm only to females of child bearing potential (<50 yo).

Malcolm, thanks so much for the article. It was very helpful. As it turned out, we sent mom's sample to our reference lab for MMA testing, and we also antigen typed her 2 brothers and her father. One of the brothers matched her Duffy and Kidd antigen types and was Coombs crossmatch compatible with her. He donated two units of packed red cells (at one donation) and was also confirmed to be Diego b negative. The patient's anti-Dib came back as clinically significant based on the MMA test. She did have a C-section after all and did not require any blood! The baby had a negative direct coombs so there were no issues there either!

Please be sure to recruit the brother as blood donor as he is a valuable donor. 

Malcolm, thanks so much for the article. It was very helpful. As it turned out, we sent mom's sample to our reference lab for MMA testing, and we also antigen typed her 2 brothers and her father. One of the brothers matched her Duffy and Kidd antigen types and was Coombs crossmatch compatible with her. He donated two units of packed red cells (at one donation) and was also confirmed to be Diego b negative. The patient's anti-Dib came back as clinically significant based on the MMA test. She did have a C-section after all and did not require any blood! The baby had a negative direct coombs so there were no issues there either!

Malcolm, thanks so much for the article. It was very helpful. As it turned out, we sent mom's sample to our reference lab for MMA testing, and we also antigen typed her 2 brothers and her father. One of the brothers matched her Duffy and Kidd antigen types and was Coombs crossmatch compatible with her. He donated two units of packed red cells (at one donation) and was also confirmed to be Diego b negative. The patient's anti-Dib came back as clinically significant based on the MMA test. She did have a C-section after all and did not require any blood! The baby had a negative direct coombs so there were no issues there either!

We usually try to
collect autologous unit if she can donate.  If mom cannot donate, you can also send out the sample for monocyte mono layer assay (MMA) to see if anti-Dib is clinically significant or if you can transfuse this patient Di(b+), had she bleed during her C section. (This test is a test that predict hemolytic potential, just like reminiscence assay performed in Europe as the journal that Malcolm has describe above. Here in the US, we used MMA assay instead of CLT). We also perform titer on the antibodies to predict potential HDFN, which is supervised by our Medical Director. (titer value more than 2 tubes difference in consecutive sample collected within a month is considered critical value here). 
Hope this is helpful. 

This may help (or may not, of course!).

We have Cerner and our test for neonates is called "Baby Type and Screen" and includes 2 orderables: "Baby ABORh," and "Mom ABSC" (mom antibody screen). Our workflow:
Transfuse order for RBCs is received in blood bank We go find the pedi lavender from hemo and add-on a Baby Type and Screen and a Crossmatch. The Baby T&S consists of a blood type on the baby-"Baby ABORh" (just a forward type, of course) and the Mom's antibody screen-"Mom ABSC." Usually we have already performed cord blood testing so we have a blood bank comment which shows the mom's name and medical record number (our cords have both mom's and baby's label on the sample and we add the comment to the baby's profile while doing the cord blood workup) We look up the mom's record to see her antibody status If no antibodies, we result the "mom absc" as negative. We select a neonate crossmatch and it is "compatible" once we scan the unit number for the aliquot. No serological crossmatching is done. We only transfuse O pos and O neg to babies. If mom has an antibody, we use antigen negative blood for the baby. Again no serological crossmatch required. We use the "neonate protocol" to override the sample expiration so our neonate samples are good for 4 months (Cerner actually calculates it as 120 days from the date of birth.) I hope this is helpful.

Interesting idea to try to get the form electronically.  We have fought for years to try and get the Admissions folks to get the patient into the computer in a timely manner so the whole hospital has access to pt. information and computer ordering.  As we try and transition to a Level 4 trauma center (yes - I know - why bother?  We already stabilize and ship), there have been improvements.  But we just discovered we still - even if the pt. is in the computer - have problems getting the name in the Lab if we are not receiving orders.  We currently have a handwritten Emergency release form - it might help us to have that changed to an electronic form so we get the order, the pt. name and the ordering Dr. - all at the same time.  All Blood Bank orders could be entered there to keep the encounter together.
For our MTP - the Blood Bank is doing all of the ordering, but an electronic order to start it might help us there too.  We are currently counting on a verbal order, followed by the handwritten Emergency release form.  We are currently starting our MTPs with 2 units    O Neg, uncrossmatched RBCs and have had 2 encounters decline additional units after receiving only those 2 units.  (Not complaining  - just noting a trend!)
Given the problems we are having getting the ER Drs to order Blood Bank correctly - I really don't know if adding even more orders for them to think about will help though. 
Thanks for the information.