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There is a CAP proficiency code "VES" (viscoelastic testing) for TEG and ROTEM testing.

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Bet'naSBB - (or any peds trauma center) - Do you use the WB for patients under 16 years as well? Is there a minimum age or weight requirement and/or a different limit to # of LTOWB units used for these ped patients? We will be participating in the MATC-II trial next year (LTOWB and TXA use in pediatric trauma) - hoping these questions are answered in the next few years so we have best practice for ped patients as well as adults!!!

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We are only doing Anti-A and Anti-B titers at this time (pediatric facility, so we aren't doing prenatal titers). I'm not sure what version of software you all are on, but when we went live with our titers on the Vision Swift and latest software version, there is a glitch in the serial dilution setup. We have to skip the 1:1 on both IgG and Buffered Card titers (doing that on the bench) and then only setup the 1:2 to 1:1024 on the Vision or we get errors. The Vision will keep trying to setup the dilution series, getting all the way to the end where it pipettes the 1:1 in the cards, and then abort the entire test. Then it tries over and over again to set up the dilution, and repeats error/setup until the sample is all used up. I sure hope this gets fixed soon - if you do titers, reach out to QuidelOrtho before taking the latest software update!!!!!!

Are there any blood banks out there who do their titers in gel on the Ortho Vision platforms? I have some questions about PT testing, correlation/competency, and testing cutoffs. We are attempting to bring our titers for Anti-A/Anti-B onto the Vision so that all techs can run and result them for our ABO incompatible solid organ transplants. Thank you!

We run our Poly and IgG DATs on the Vision. We make up our own in-house pos/neg DAT samples as recommended by the Ortho rep. Here is our procedure to prepare those tubes and labels below. If you don't have an SCD, you might be able to enter a unit that was expiring, but you'd have to establish some sort of expiration for the cells/sample then: 1. Select an Rh Positive red cell unit with a good outdate from the available inventory. 2. Complete a label with the lot “DPMMYY” (using MMYY as the month and year of preparation; i.e. “DP0521”). Add the expiration date equal to the expiration date of the red cell unit as well as the date prepared and your initials. Place a barcoded P10000 LIS accession label on the vial so it can be scanned onto the Vision. 3. Complete a label with the lot “DNMMYY” (using MMYY as the month and year of preparation; i.e. “DN0521”). Add the expiration date equal to the expiration date of the red cell unit as well as the date prepared and your initials. Place a barcoded N20000 LIS accession label on the vial so it can be scanned onto the Vision. 4. Connect a syringe set to the red cell using the Sterile Connection Device and remove approx. 10mL of packed cells. Place the red cells evenly into two plastic 12x75mm test tubes (one labeled P10000 and the other with the N20000 label made above). 5. Add 2 drops of Anti-D (Ortho Bioclone) to the P10000 packed cells, mix well, and incubate for 30 minutes at 37°C. Mix again about half-way through incubation. 6. Test each of the prepared red cells by performing a Poly DAT in gel on the bench. Ensure that the results are 1-3+ on the P10000 cells and negative on the N20000 cells prior to placing the vial into use.

We’d like some input from other pediatric hospitals (or those who transfuse pediatric and neonatal patients) on rbc indications as we further develop our patient blood management program: · What are your indications for rbc transfusions? (Hgb thresholds/other justifications for ordering practices) · Do you monitor those justifications, and if so, what is your compliance rate and goal? (i.e. % RBC txns below 8g/dL – usually at 60-70% with a goal of 80%) Thanks so much for your time!

We were sighted by CAP for this and had to go back to manual temp alarms (placing all of the probes in the water bath rather than using the electrical check). It is also in the guidance in the online version of the AABB standards, standard 3.7.

Yes, you should do at least a small parallel study using the old and the new. Your director will have to decide on how many would be acceptable and define acceptability criteria prior to implementation. I would summarize and have them sign-off before placing it into use.

Pediatric hospital - we have been transfusing both PAS and pathogen-reduced platelets to our patients since April of this year, including neonates. We have only had one minor allergic reaction reported from PAS to date, and it was an older patient (teenager).

The extra spin is not recommended by Ortho. We definitely see some lots/shipments that have more rejections than others. It was requested by Ortho that we contact technical support when this happens so it can be reported and they will replace those effected cards. We actually had a problem around a year or so ago that led to a lot of troubleshooting with the card manufacturers by Ortho. Reporting to them is really the only way to find out what the root cause is - problems during shipping or manufacturing could all play a role.

The standard in 5.14 quoted above states that pre-transfusion requirement for any allogeneic component is an ABO group and Rh type. It does not state that this has to be done within 3 days or on the current admission. As we can see by the responses, some facilities are requiring confirmation on the current admission and others will go with historical ABO/Rh for a plasma/plt/cryo transfusion, and I can definitely see arguments for either side; bottom line is, this is not a regulatory requirement and must be defined by your facility. There is a standard that requires the pre-transfusion testing within 3 days if transfused or pregnant (5.14.3.2) - but the entire section for 5.14.3 is regarding the antibody screen for WB/RBC/Gran transfusions, not the ABO/Rh only.

Agree - also, what blood type is the mother? From an operational stand-point you have a couple of options: Call the blood type "indeterminate" or "unable to determine" or call the baby AB. Either way, we would suggest repeat testing at 4-6 months and include A1 lectin typing if discrepancy still exists. In the meantime we would give group O red cells and AB plasma/platelets until resolved.

We also use a communication log that others are referencing here. Each tech is required to read the communication log since the last shift they worked EVERY DAY as one of the first things they do as they enter the Transfusion Service. We have been doing it for years, and it has now become second-nature. Anything that has to be handed off must be recorded by the outgoing staff, and anything else to speak of (patient using frequent products or an OR or MTP that used a lot) is also helpful. We also instituted a huddle board (dry-erase board at the end of the room) and do a standing huddle around 3pm everyday when we have the most staff and are usually the busiest. Even the Transfusion Service MD on-call participates in the huddle and it has helped out with our team communication!

You should be able to check with your blood supplier to see what codes they will be using. We use the Red Cross and have only built E8340, E8341, E8342, E8343, and E8344 thus far.

We perform neonatal exchange transfusions on only one to two patients per year. We are a large free-standing pediatric facility in Ohio with about 525 beds (includes about 130 inpatient neonatal and 150 offsite neonatal beds). We provide reconstituted whole blood since we are already FDA registered (see related thread on RWB for exchange txns). A baby who needs an exchange who is at our offsite neonatal units at our partner adult hospitals should be transferred in-house on main campus for the exchange procedure. It is a manual push-pull process, usually performed by the NNP in the NICU. The RWB is not required but does make the process easier for the clinician as opposed to alternating prbcs and plasma. Stephanie

We also used to do electronic checks quarterly, but now that there is specific guidance to standard 3.7, we have reverted back to the old water/ice alarm check. This is from the AABB portal on the guidance for standard 3.7 in the 31st edition - "An electronic alarm test that merely increases or decreases the electronic digital readout to determine if the audio alarm sounds, would not meet the intent of the Standards." The full checklist item and guidance are attached. AABB Standards 3.7 and guidance (31st edition April 2018).docx

I don't have any good reference material for you, but I can say that we use adsol units for all of our MTPs, regardless of age/size. We do have different MTP packs based on the patient's weight ranging from 1 rbc: 1plasma :1 plt to 4 rbc : 2 plasma : 1 plt pheresis. We are a free-standing pediatric Level 1 trauma center with about 30 MTPs per year.

Sounds like an amazing program - Congrats to your team!