YorkshireExile

We recently got some new refrigerators and for the alarm checks there is just a button we press for high and low alarm checks which automatically cools or warms the temperature of the probe. This only affects the probe - the chart pen does not move. i would presume all modern refrigerators have this function. Why should I have to mess around with the probe, taking it out of its container and placing it in warm or cold water - possibly damaging it in the process - all so that the pen on the chart can move? Aren``t these automatic probe checks, with retreiveable documentation, good enough for CAP?

Thank you for the replies. What about another couple of scenarios we are considering. If an automated blood group is ever edited for any reason, does that disqualify from doing the EXM? If for some reason a RBC unit is not entered electronically into your inventory in the computer using the barcodes, but is instead entered manually, does that disqualify from doing the EXM?

We are currently validating the use of electronic crossmatch in our hospital. For those hospitals who currently do EXM, if the DAT is positive does that mean that sample is not valid for EXM? If so, how did you validate this? We are having difficulty to make a positive DAT part of the criteria for EXM exclusion. All we can think of is to add Positive DAT to the list of antibodies under antibody ID so it would then be recognised. The computer system we are using is Cerner Millenium.

Could you send me a copy as well? We recently re-designed our competency assessment to meet the six elements that CAP says you have to include, and it seems so cumbersome and lengthy now. Thank you.

Smiller - When you say you have done a "recent" pos DAT workup, how do you define recent? What time frame?

And if not pregnant or not transfused within the last 3 months?

What do people use as the criteria for when to repeat antibody investigations? If the previous sample was only three days old, and the new antibody screen was positive with the same strength reactions as the three day old one, would you do a full antibody workup again? What if the previous sample was seven days old or even one month old? When would you repeat the full antibody workup? if the patient has been recently transfused or is pregnant would that affect when you repeat your antibody work up? Interested to hear what you all do.....

For our hospital the donation center does not provide whole blood so we have to reconstitute PRBC with plasma to make an exchange unit. I would like to ask Malcolm what type of red cells are used for exchange transfusions in the UK? Is it CPD-SAGM or just CPD units? We get CPD-SAGM units from our supplier and have to centrifuge the unit to remove the SAGM, then we add plasma to achieve a HCT of around 45 to 50%.

Does anyone use RBC expiration rate for their monthly quality indicators (key performance indicators)? If so, what do you use as your denominator? Do you use number of RBCs transfused in the month or the the number of RBCs received from your blood supplier per month? We use number of RBCs received from our blood supplier as we wanted to monitor we don`t excessively order blood that may not be used and expire. But now I have read that this may not be correct. Also, what is your target? We state our expiration rate should be <2%.

Thank you Baby Banker and Neil for your recent input. So as we are using leucoreduced blood, does that mean that a blood unit would never be implicated in causing CMV infection in a recipient? Or there is. and always will be, a very small risk a leucoreduced unit can cause a CMV infection?

Thanks Malcolm, So you are saying that blood should be leucoreduced and CMV negative for the categories that I stated? What if the blood donation center that supplies my blood does not do CMV testing? All I can do then is give the leucoreduced blood. On a similar topic, we had a newborn baby receiving a number of leucodepleted RBC top-up transfusions since birth. At 35 days old the baby had a CMV quantitative screen done and was CMV negative. At 65 days old the baby was tested again and the CMV screen was positive. Is the reason for this purely down to one of the transfused units? Or could other factors be involved eg infection passed on by another healthcare worker, or by the family, or by environmental causes?

All the blood in our hospital is leucoreduced, and we have classified this as "CMV safe". But is this actually the case? Is leucoreduced blood the equivalent of CMV negative blood? For the following patients would you just give leucoreduced blood, or leucoreduced blood that is also CMV negative? Intra-Uterine Transfusion Exchange transfusion for a baby Top-up transfusion for a premature baby Top-up transfusion for a full term baby

I`ve just read a new article in CAP Today concerning the RHD genotyping of Rh Negative patients. Link to the article is : (hope the link works) http://www.captodayonline.com/groups-urge-phase-rhd-genotyping/ What do people think about this? Is anyone sending samples from Rh-negative patients for RHD genotyping as a routine? Is anyone thinking about doing this? Do many labs do no further work-up on a Rh negative pregnant patient? My lab does a Biorad Weak D confirmation test only on Rh Negative cord blood samples, not on routine antenatal patients. We use a biorad grouping card on our antenatal patients that will show a weak agglutination with anti-D if the D antigen is weak, so we would just say that the patient is actually weak D positive, but would treat the patient as Rh Negative with regards to transfusions or Rh immune globulin. Of course, we don`t know for sure if it is a weak D, or a variant D etc. Am I wasting my Rh Negative blood stocks and Rh immune globulin as stated in the article? Should genotyping become routine?

Thanks for the information John. You mention that AABB has a validation program for the pneumatic tube system. Is it available on their website? I had a look at couldn`t find it anywhere, but maybe I was looking in the wrong place.

Thanks so much Goodchild - a fantastic answer!

I`m working in a new hospital and we had a pneumatic tube system installed to transport specimens from the wards to the lab. I`ve now been asked to see if it is okay to transport blood products through the pneumatic tube (in appropriate special containers). At first the thought of doing this horrified me, but there are papers published that say this is okay. Is anyone doing this with their blood products? Presumably it might be useful to send products to the OR quickly, but what about checking the units and the documentation involved? I can forsee many problems!

Thanks for all the replies. So it seems in UK a form is needed to be sent with the specimen, but in USA no form is needed. Is that okay with CAP and AABB?

Is it a requirement by CAP or AABB standards that all blood bank specimens must be accompanied by an actual manual paper request form for tests such as Type and Screen or Type and Crossmatch? I always thought it was, but now I`m not so sure. The form could be computer generated when the doctor places the order. Previous hospitals I have worked in insisted on this so we could compare the details on the form with the details on the specimen, but if you have a good computer system where you can see all the ordering details for checking, is an actual paper form really necessary? My current hospital wants to reduce paper forms (well, remove them altogether) and if I want to keep for blood bank I need documentary evidence to prove why I need forms or evidence that accrediting bodies require forms. So forms or no forms with BB specimens?

On behalf of a colleague: Whenever we issue a blood product we employ the 30 mins rule for it to be returned if it is not used. If returned unused after 30 mins we would discard the product. We strictly apply to this blood units (even though there is no direct evidence for the 30 minute limit, as has been mentioned previously in this forum). Does everyone also apply this rule to FFP and platelets? Would you discard these units if returned after 30 minutes? For those who would, is there any difference if the FFP is actually issued straight from being thawed in the waterbath so it is still relatively warm, or if the FFP is issued cold after being in the fridge for a while. Would the 30 minute rule apply regardless?

We have chart recorder and the digital readout for our fridges and freezers - but we also have external digital thermometers in place at the top and bottom so we can check the temperatures inside are okay overall. Are the external digital thermometers really necessary?

Dear Auntie-D, which UK guideline mentions the third check? Thanks

We are not in the UK, but apart from mothers with antibodies we only do grouping and DAT on babies whose mother is group O or any group Rh negative. Interesting on your choice of Biorad card. We use a Biorad newborn card that only has one anti-D well but has an anti-AB well, as sometime we get very weak reactions with the anti-A and/or anti-B and we use the anti-AB as confirmation. Is using two types of anti-D common for grouping babies (and adults for that matter)? John - what do you do next when you have a grouping result with one anti-D well negative and one anti-D well positive?

Only medicine we could find out that the baby had was Prostin.

To clarify, the baby received IVIG after the initial samples were drawn. So all the positive results were pre-IVIG administration

Okay, now have further information about the baby: The baby has not been transfused before and as far as we know the mother had no transfuson during the pregnancy. Baby transferred from another hospital to us on day 5 and underwent aortic arch repair and VSD on day 8. The surgery was postponed 3 days for IVIG. One aliquot of incompatible blood was transfused prior to surgery, one whole unit during the surgery and one aliquot post surgery - all 2+ incompatible. - Baby is recovering fine from the surgeries, second one was to close the chest. - Both parents are Bpos. - Baby is not septic We also did a 16 cell panel screen, all 2+. Rh phenotype mother and baby both R2R2. Bilirubin on day 5 was 215, today it is 52.9. Baby also received plasma, platelets and cryo at the time of surgery. Probably enough blood and plasma for the equivalent of a full exchange. Any further ideas?