YorkshireExile

May I ask - What QC do you do when the cell saver is used?

Our blood supplier is shortly going to be introducing FFP Riboflavin treated, and Apheresis plasma Riboflavin treated. We have been told that the ISBT codes to use are EA435 and EA436. Does anyone know what the ISBT codes are for these products when they are thawed or aliquoted? I do not have access to the ICCBBA website so I cannot check on there.

Our blood supplier is shortly going to be introducing FFP Riboflavin treated, and Apheresis plasma Riboflavin treated. We have been told that the ISBT codes to use are EA435 and EA436. Does anyone know what the ISBT codes are these products when they are thawed or aliquoted? I do not have access to the ICCBBA website so I cannot check on there.

In our hospital, KBs are performed in the haematology department. If positive, the amount of mls bleed is calculated and documented. The RhIG is then given out by pharmacy based on the package insert information and after discussion with the doctor. Would an AABB inspector even look at this process in our hospital as Blood Bank is not involved at all?

CAP / AABB state that any records of transfusion problems, such as finding unexpected antibodies, should be retained indefinitely. Does this apply to patients who have a positive antibody screen only because they have recently received a confirmed prophylactic passive anti-D injection? Or do I only need to keep the antigrams of these patients for ten years? Or I don`t need to save them at all? Wondering what other facilities do with these patients?

Mrmic, are you saying that a prestigious an institution as the British Committee for Standards in Haematology is wrong in this recommendation? - Quote " Routine irradiation of red cells for transfusion to preterm or term infants (other than for EBT) is not required unless there has been a previous IUT". Even though they reviewed relevant publications over an eleven year period? Note it is only a recommendation.

No bad outcomes at all. So I suppose your next question would be " then why change anything?" Which would be a good question!

In my hospital we irradiate all blood for neonatal top-up transfusions, and because we reserve units for the neonate to reduce donor exposure, some blood is even irradiated up to the unit being 35 days old. All irradiated blood is transfused within a few hours. I have just belatedly read the 2020 British Committee for Standards in Haematology (BCSH) guidelines for the Use of Irradiated Blood Components. These guidelines are now saying that blood for neonatal top-up transfusions does not need to be irradiated (with a couple of exceptions of course, such as after an IUT). They also state that blood should only be irradiated up to the unit being 14 days old, and then the unit can be used for up to 14 days afterwards, even for neonates. So my questions are: What are other facilities doing for neonatal top-up transfusions? Is the blood irradiated or not? If it is irradiated do you transfuse as soon as possible, or the unit can be used for a neonate up to 14 days post irradiation? Do you irradiate units that are more than 14 days old? Do you reserve a blood unit for a neonate for the shelf-life of the unit, or do all your neonates get as fresh blood as possible?

Congratulations!!

Which Standard number is this?

Slightly off topic, but we don`t wash our units for IUT. What anticoagulant for the blood collection do you use? We use blood collected in CPD with no SAG-M added, which normally has an HCT of around 80%. So no washing is required.

Congratulations!!

Hi Malcolm, you mention that in massive, urgent transfusions to give Rh and K-matched blood for females of child-bearing potential from the age of 0. What about routine top-up transfusions for female neonates from age 0? Should they get Rh matched blood? Or only from four months old onwards?

Thank you all for your suggestions and helpful information. Unit has been returned to supplier as there is no way we could use it for any patient. Investigations are underway....

We have never used a lectin panel before. Are these commercially available?

We have one unit of group O positive blood that we unexpectedly got a 4+agglutination by tube and a 2+ agglutination by gel card when we crossmatched to a patient with a negative antibody screen. We did a polyspecific DAT and a monospecific DAT by gel card and both were negative. Group and antibody screen of the donor was checked and was confirmed O positive with negative screen. We then crossmatched the unit with five random patients of different groups who all had a negative antibody screen. The unit was incompatible with all five patients. What could be the reason for this one unit being incompatible with supposedly different "normal" patients? I feel I am missing something obvious here? Should we send the unit for culture?

For anyone who is washing red cells, what do you use as your quality control criteria for the final product? Is it based on any standards? I have looked at AABB standards but cannot find anything specific there. What is the HCT level you are aiming for? What is the protein level you are aiming for? Any other criteria?

Melanie - I have sent you a PM

We also test for Weak D`s on Rh negative babies of Rh negative mothers. The CAP TRM: 40780 says you have to anyway. I think in about 13 years I have seen two babies that were Weak D positive.

My hospital is looking to begin stem cell / bone marrow transplants, but the lab will only be involved in receiving, assigning and issuing the product. The actual collection and processing will take place at another site before the product is sent to us to issue to a a patient. We use the Cerner Millenium computer system. Are there ISBT labels that we can use for these products that have the code available in Cerner software? I have been told that we need to get third party software for this as Cerner does not support cellular therapy products. Can anyone who has Cerner and transfuses cellular products say how they label the product, what ISBT codes they use, and how the product is received in Cerner?

You are lucky you have retired! Definition is (I think!) - a parameter associated with the result of a measurement, that characterizes the dispersion of the values that could reasonably be attributed to the measurand. The ISO requirement we are supposed to meet is: 5.5.1.4 Where examinations include a measurement step but do not report a measured quantity value, the laboratory should calculate the uncertainty of the measurement step where it has utility in assessing the reliability of the examination procedure or has influence on the reported result. The explanation is this: To ensure that measurement results are useful and safe in medical practice and to permit meaningful comparison with medical decision limits and previous results of the same kind in the same individual, medical laboratories require estimates for the overall variability in values reported by their measurement procedures." I imagine that all makes you none the wiser!! Sorry - I couldn`t do it in 50 words!

This question may be mainly for UK Blood Transfusion labs, but we have just had an ISO 15189 inspection and our inspector says we should be doing Uncertainty of Measurement (UoM) in Blood Transfusion labs, especially with regards to Blood grouping. Now, I have no idea how UoM relates to Blood Bank procedures, and my inspector failed to convince me, but he said that this is quite common in the UK now and many Transfusion labs are doing this. So for anyone working in a UK Blood Bank who are ISO 15189 accredited, are you doing UoM calculations for any BB procedure? If you are, can you please explain to me how it is relevant and what are you actually doing? UoM is relevant to Haematology and Chemistry with all their CVs and SDs and Bias calculations etc, but what the heck has it got to do with Blood Bank work!

We were told by our CAP inspectors that we need to include evidence on our competency form that all the tasks were actually done. We had to include MRNs, or Accession numbers, or product unit numbers. I can`t see any space on you form to include these details. Do you add them, or do you just fill in the date/method boxes?

Thank you "Byfaith". it does help! Have you ever had any problems performing EXM with Cerner Millenium? Or is it all good as long as the EXM rules are built correctly?