Townsend

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.

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 will do a pre-darzelex blood type and antibody screen as well as antigen-type the patient for all antigens that we have anti-sera for.  When transfusion is needed after the darzelex is started, we will use phenotypically-matched packed cells.  If the patient specimens don't come until after the patient has received the drug, we send the specimens to our Red Cross Reference Lab buddies to work up for us.  They use the DTT (not DDT!) and antigen-type the patient to provide information for our future use.

If your patient is Kell Negative (Ko) you have real problems.  If your patient is K Negative, you, and your patient, have more chance!

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 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.

We use both pre-pooled cryo from our blood supplier and in-house pooled cryo.  We are a pediatric hospital, so we may pool only one or two units depending on patient weight.  We do not add saline to the pooling process, and there is very little cryo left in each bag.  I am curious - what diagnosis or indication requires 36 units of cryo?  I would like to learn a bit about that.

We preform our own acid elutions in-house, but this flowsheet may still be of use on whether or not to sendout for an elution.  I've attached our flowsheet here:
Stephanie
Elution Flowsheet COMPAT SER FS4.doc

I've attached our validation plan that we used last year.  Some of it is Sunquest-specific, but hopefully you find it useful.  You will find more detail regarding Ortho's guidelines in their Validation Manual.  Our plant was to ensure we were doing approximately one week's worth of samples, but we ended up doing a lot more than that to work out some kinks we found during testing and to ensure that we had a good assortment of antibodies and scenarios.
Stephanie
Vision Validation Plan.doc

At this time you can't put partially used cards back on the Vision.  This is something to consider if you are a smaller/med size hospital or if you are planning to use Poly IgG/C3 cards for DATs.  They are willing to give customers a credit for unused wells, so don't let that stop you from making a decision about using (or not using) the Vision for a specific card/test.  We are told that you will be able to put partially used cards back on the analyzer with the next software upgrade, so time is TBA.  There is also supposed to be a change in how long partially used cards can stay on the machine until they are "kicked off" - right now it is only 4 hours.
We are still validating, it has taken some time to get this set up for pediatrics and get the interface going with Sunquest.
Stephanie

We preform our own acid elutions in-house, but this flowsheet may still be of use on whether or not to sendout for an elution.  I've attached our flowsheet here:
Stephanie
Elution Flowsheet COMPAT SER FS4.doc

If you are retyping in the computer, the labels shouldn't be required as long as you have a way to distinguish between units which are available for crossmatching and those that still need retyping. We do this by placing all unconfirmed units on a designated shelf until the are retyped.
Stephanie Townsend, MT(ASCP)SBB

We preform our own acid elutions in-house, but this flowsheet may still be of use on whether or not to sendout for an elution.  I've attached our flowsheet here:
Stephanie
Elution Flowsheet COMPAT SER FS4.doc

We preform our own acid elutions in-house, but this flowsheet may still be of use on whether or not to sendout for an elution.  I've attached our flowsheet here:
Stephanie
Elution Flowsheet COMPAT SER FS4.doc

We preform our own acid elutions in-house, but this flowsheet may still be of use on whether or not to sendout for an elution.  I've attached our flowsheet here:
Stephanie
Elution Flowsheet COMPAT SER FS4.doc

We preform our own acid elutions in-house, but this flowsheet may still be of use on whether or not to sendout for an elution.  I've attached our flowsheet here:
Stephanie
Elution Flowsheet COMPAT SER FS4.doc

I've attached our validation plan that we used last year.  Some of it is Sunquest-specific, but hopefully you find it useful.  You will find more detail regarding Ortho's guidelines in their Validation Manual.  Our plant was to ensure we were doing approximately one week's worth of samples, but we ended up doing a lot more than that to work out some kinks we found during testing and to ensure that we had a good assortment of antibodies and scenarios.
Stephanie
Vision Validation Plan.doc

Just thought I would confirm from an earlier reply of mine that you can now load partial gel cards onto the Vision.  This is after their software upgrade that came out near the end of 2016.  You should not load partial cards that have had any columns run by manual testing, but you can load it back on if it was only used on the analyzer.  The partial cards are loaded in the manual review rack (dual purpose drawer) and they are held in the middle incubator (not in the main gel card drawer).  If the card is not used in 4 hours, it will get spit out again in the manual review rack.  You can re-load it again if you would like to; or if it is a less frequently used card, like the Poly cards for us, then you can wait and re-load it once you need that type of card again.
Hope this makes sense and is helpful.
Stephanie

We use a sterile connection device to attach either a transfer bag or a syringe (the syringe has an in-line filter attached).  We label the bag/syringe with the 4x4 ISBT label from the Hematrax label printer containing the new division number.  After mixing the contents of the platelet component, you open the weld and transfer the needed volume into the bag/syringe.  We add an extra 5ml to a syringe or about 15-20ml extra for a bag aliquot (since the bag still has to be filtered prior to transfusion).  All platelet aliquots are given a 4 hour expiration time from preparation.
Stephanie

We use a sterile connection device to attach either a transfer bag or a syringe (the syringe has an in-line filter attached).  We label the bag/syringe with the 4x4 ISBT label from the Hematrax label printer containing the new division number.  After mixing the contents of the platelet component, you open the weld and transfer the needed volume into the bag/syringe.  We add an extra 5ml to a syringe or about 15-20ml extra for a bag aliquot (since the bag still has to be filtered prior to transfusion).  All platelet aliquots are given a 4 hour expiration time from preparation.
Stephanie

We use a sterile connection device so that a closed system is maintained (and no hood is used our Transfusion Service for any component prep procedure).  If you use an open system such as spiking the port directly with a syringe set, the parent (A0) unit will expire 24 hours from entering.  All of our syringe products prepared are given a 4 hour expiration.
Stephanie

We also outdate our aliquots 4 hours from prep and use a sterile weld.  This allows us to dedicate a unit to a couple of babies.  Our irradiator has a syringe adaptor that lets us irradiate exactly the amount they request.

We use a sterile connection device so that a closed system is maintained (and no hood is used our Transfusion Service for any component prep procedure).  If you use an open system such as spiking the port directly with a syringe set, the parent (A0) unit will expire 24 hours from entering.  All of our syringe products prepared are given a 4 hour expiration.
Stephanie