[Hepatitis B antibody (titres) for staff]

The Blood Bank dept. at my VAMC performs the HIV/Hep testing for the hospital. We do all the viral marker testing for employees as a service, which it definitely should be. Good Luck!!

[Removing serum from cells]

Hey Malcolm-

Our work volume is small--usually one sample at a time. We only remove the plasma if the crit is really low and immediately replace it. If it is a type and match-of course, respin.

[Tissue Bank]

Yes, if the tissue leaves your control, you have transferred it. We are the only VA hospital in the Southeast that orders, receives, stores, distributes and tracks tissue used in our facility--only because the OR could not do it.

It is in our policy that we will not transfer or receive tissues from outside facilities(hospitals) as we do not know the control status of these facilities ( even though they are next to us, share physicians in dire emergencies, etc.)

[Removing serum from cells]

We use the gel system and plasma is recommended. We only remove the plasma if the patient has a low crit to access the RBC for the red cell dilution in order not to contaminate the pipette. Then we immediately replace the plasma back into the original tube.

[Just For Fun]

How about this one!! We are in the process of validating new BB computer software. I had just finished writting a test script to validate ISBT. My supervisor asked me why I wrote the test script--because we had already validated ISBT--well yeah- on the current software. I am lost for words at this point!!!!

[How many times do you perform an antibody identification?]

We follow a 10 day rule that if the patient is still in our hospital and if the strength and specificity of the screen and/or DAT is the same, we do not repeat. Of course give antigen negative for the the offending antiboby determiined with the initial sample.

[Clinically insignificant antibodies]

If the M spills to AHG, M negative, crossmatch compatible untis. For the others..crossmatch compatible through all phases.

[thawing ffp]

At my facility, we thaw FFP for 15-30 minutes at 30-37 degrees. If temp reach over 37, the heat labile factors can be destroyed.

[Asking for help SBB exam emminent]

Being a little late, I am sure you did well. I studied for the BB way back in 87 with a newborn at home--just reviewing the Tecnical Manual. I am sure you did wonders!!!!

[Cooler validation/ QC]

Brenda, At our facility we have validted all our coolers (same brand) using only two random coolers. I do not think this needs to be done repeatedly if there is a HemoTemp or other temperature indicater placed on the units at issue.

[when to perform red cell elution]

I have worked in Blood bank for 30 years and recently transfused has always been 3 months. If there is a doubt that the patient has been recently transfused (i.e. patient incoherent) do an eluate.

[FDA Inspector]

I have been in blood banking since 1985 and I have always noticed that the FDA inspectors for Transfusion Services have no corellation at all with our field (nurses, food inspectors, etc). I have worked at a blood center and the FDA inspectors seemed to have knowledge of the processes. I see no difference between the two and I guess this is just a fact of life. I would contact the FDA--you can always protest with proper documentation.

[Witnessing Blood Bank Draws]

We have two individuals present at all BB draws. It can be any combination of personel except not 2 phelbotomists or LPNs. Med, nurse or lab students are not allowed to participate in the drawing of BB samples.

[Computer Validation]

I intrepret this as to mean that validation must be performed in user environment and using processes applicable to that site.

[Re-testing antibody screens]

Do not repeat due to possibility of titer issues--give antigen neg blood for previous ab.

[what type bag do you issue blood products in?]

We do not send any blood products through the tube system as a "person" must be documented as responsible for the product when it leaves our control and reaches the nursing staff.

[Safety Vue Indicators]

I do not have any experience with Safety Vue. Our ER does not handle traumas and therefore we do not send blood to them unless one unit to hang while the patient is transferred to Intensive Care. Regarding the coolers and our use of HemoTemp II in OR, we give them a call 3 hours and 30 minutes post issue to ensure that the blood has been used or to have them return the cooler to us for reicing.

Any unused blood returned to the BB is inspected, HemoTemp temp recorded and returned to the refrig. We remove the temp indicator at that point. Our OR has been very receptive and cooperative in keeping the coolers closed when blood is in them. We do a daily visual check for hemolysis, etc when performing the daily inventory. Users of HemoTemp, should we leave the indicator on the unit on return from OR? Suggestions?

[Safety Vue Indicators]

We use the HemoTemp II indicators. About 15 years ago the OR had a monitored refrig, we gowned up and manually took the temp every morning. We had an incident where an O patient was given A red cells--DIC, death. The refrig was taken from OR. We have six coolers and even though they are all the same type, each was validated individually. We could not be sure that the OR kept the lid on, etc after issue so we incorporated the indicators for patient safety.

[When does the clock start.....]

I must also add that I have inspected for AABB and CAP and considerering my sites inspections the 4 hour limit from time of issue is a common sense type of view.

[When does the clock start.....]

Our clock starts 4 hours from the time of issue also!! That is the point where it is taken out of mandated conditions.

[FDA Software Validation]

The National VA office has released a new BB computer system earlier this month. Yesterday I was involved in a teleconference regarding what all acediting agencies would be looking for. A question was asked from Kansas regarding close faclities on the same server (Leavenworth and Topeka) as to if one facility could validate and use documentation for both. As it was pointed out, each facility has different BB procedures and validation at the facility will cover this. Any hardware or software is validated by the supplier before release, but we must validate the system to our own processes. Hope this helps.

[Cell Saver QC]

At the VAMC in Jackson MS, we have a Haemonetics 5+ Cell Saver. We only perform about one case a month. Our QC indicators include on the first bowl a Hct, plasma free hemoglobin and a culture. Due to our lack of frequency we felt that including a culture with each case was appropriate.