[Advice needed please!]

concerning the elutions, we only do the elutions on cords if the mother has a significant antibody.

[Phlebotomy Charges]

To the best of my knowledge, we only charge for the procedure itself, but it has been soooooooo long since we have done one thank goodness.

[Could this be possible?]

I have some nurses and neighbors also, if you are looking!

[Trm.31450]

We just had our CAP survey, and this Question was the only deficiency that was found in my department. I had actually answered this as because we test our QC in both tubes and gel each day, I was under the assumption that this would be sufficient, but we all know what assuming does. The answer that I received from my surveyor was that because QC materials are manufactured these cannot be used for the validation/correlation studies. What was suggested by my surveyor and also another aquaintence who is a AABB surveyor is to test a couple of samples every 2 to 3 weeks or so so that there is continuous testing occuring which in their oppinion looks better to the surveyor than only performing this twice a year.

[BCTA]

Is there anyone out there that has gone live with BCTA as of yet? We go live in the AM. Please what are some of the problems you have encountered?:confused:

[Weak D Testing Policy]

We perform a weak D on all patients without previous histories who test negative on the Gel. Babies are tested for the weak D also. All OB patients who test as Rh negative have a weak D performed irregardless of their history. As to how many, we do approximately 15 OB patients a day with about half having no previous history.:cool:

[CAP Proficiency Testing for Blood Bank]

I cannot see how this would be a problem. You receive 5 samples for the antibody screen/id. Just insure that you include all names on the last page of testing personnel.

[I promise this is the last time...]

I require 1 full Pink EDTA tube for all inpatients, and 2 full Pink EDTA and 1 full Red top tube for outpatients in the unlikely incidence that they should have a positive antibody screen. As for labeling I use the Hollister cards and as you probably know there is a big specimen label to this the collector must affix either one of our laboratory labels or a hospital label. In either case the full name must appear on the specimen(s), if it is too long to be included on the label, then it MUST be written in. Also the patients medical record number must be included on the labels as well as the DOB, the date of collection, the time of collection, and the initials of the collector. If there is any deviation then I have a special filing cabinet that is colored red where the specimens are stored, in other words they are discarded as being unacceptable and there are no exceptions. I require them to be labeled the same throughout the house. The rest of the laboratory is a little more lenient when it comes to labeling, they will allow the collector to "fix" the discrepancy if it exists. In my humble opinion no one has ever died because they had an incorrect WBC count or at least disabled they way they could if there was an incorrectly collected specimen.:cool:

[Cold Autoantibody]

How common is the practice of routinely running both a regular and ficin-treated panel? It seems that such a practice (like routinely reading tubes at IS, which has somewhat gone out of practice) just leads to unnecessary complications and lots of time & energy chasing clinically insignificant antibodies.

Like Malcolm we do the same thing for all antibody id workups except we use PEG instead of Ficin or Papain, and unlike Malcolm we are a hospital based transfusion service.:D

[Specimen for Fetal Screen]

Upon completion of the cord blood workups, if the patient needs the rhogam workup to be done, they are drawn with the next blood draw, usually the next morning with their HH. We went thru this recently with our L&D nurse manager and she could not find nor show me documentation that they must be drawn within the first hour post delivery.

Ultimately no proof, no time change.

[Blood Type cards for patients?]

Just as a matter of interest, would you (and others) not also find it useful for clinically insignificant atypical alloantibodies that cause many serological problems, both in identification and cross-matching, such as anti-Ch, anti-Rg, anti-Kna, anti-McCa, etc???

:confused::confused::confused:

I see the error of my ways. We issue cards for all antibodies not just the big ones (E,C,e,c,K, etc.) because any and all could cause us trouble.

[Blood Type cards for patients?]

Yes we do, but only for those with significant antibodies. The reasoning behind this is to help "me" out in the future when they come in again, or go to any other facility for transfusion. It helps if you know what you are dealing with before you actually have to deal with it.

[Just For Fun]

Had one just yesterday, patient seen in the ED with warfarin toxicity and GI bleed. Patient family informed the ED staff that she had history of antibodies. Patient transferred to the floor, where she continued to go down, her Hgb got to 4.1. Her admitting wanted blood (which she did need) and needed it now. So he called to inform me that he wanted to give the patient 3 units of blood and to get him 3 O negs ready since the O negs dont have any antigens present. Long and short he got 2 B Pos and 1 B neg. The patient it turns out has a C,E,D,Lea,Fya, and Jkb. Of course he signed for them.

[What do "you" do??]

For FFP, Platelets, and Cryo, we accept a historical type to assign the unit, but do require a current Type and Screen to be on file.

[Wise Ole Sayings]

As I stated in a previous reply:

"YOU GET WHAT YOU GET, AND YOU DONT THROW A FIT":D

[Advice about Emergency Release]

It looks as though my protocols are following what others are doing. The ED doc gets O Neg PC and AB FFP. As my daughters kindergarten teacher used to say, "You get what you get, and you dont throw a fit!!"

[Undetermined Rh in Meditech]

We also are using Meditech-Magic at our hospital. I was not responsible for setting up the truth tables etc. but I do know that if we need to do a weak D tedt (formerly Du) we add the test to the patient's accession number and result the test. We only do the weak D test on babies of Rh negative mothers to determine RhoGam status. We do not use the terminology 'undetermined Rh'-I am curious why that would be used. Does 'undetermined Rh' get reported out on some of your patients? Is this a common practice?

The only reason that I can see for reporting an undetermined Rh on a baby is if the DAT is positive with a negative Rh.

[can you tell if Rouleaux is present just from looking at the gel card?]

Ditto

[Meditech ISBT Help!]

The easiest way that I found while dealing with your dilema was to build product groups, I have 8 different product groups (cryo, cryo pooled, ffp, ffpcp, pc, plt, tcryo, and wb). Once you have your groups built, you can activate all your products and on page 1 of the product dictionary input your product group in the group selection spot. Then on page 3 of the same dictionary under the substitute product field input all of your activated products plus your product group. On the same page in the substitute product group field, enter your product group. This way if the floor orders a unit of packed cells, you can pull any compatible unit from the shelf and issue to the patient because everything is tied to a group not an individual product.:coffeecup

[massive transfusion]

Our MTP has not been tested to its fullest, but it does work when confronted with a massive hemorhage in the L&D. I have uploaded my policy minus the headers and all.

MASSIVE TRANSFUSION POLICY MTP BB-125 2.doc

[retention of used blood bags]

Also we do not require the used bags be returned to the blood bank, unless of course there is a reaction going on at the time.

[retention of used blood bags]

It appears that we are following suit here with a lot of the members out there. When we issue a unit of blood, we pull a segment from the unit and include it in the tube with the original segment used for testing. I have 4 big racks that are used for this purpose, when one is full, I discard the oldest rack in the refer (usually about 2-3 weeks old), and start refilling with the new segments.

[False Positive Anti-D in Gel?]

Since this patient is an OB, her baby was typed from the cord blood. The baby typed as A+ with a negative DAT, while the mother is O=. Fetal screen (rosette) was a weak 1+ reaction, with a negative DAT. We feel that this mother is suffering from a fetal bleed, KB stain/flow sent off to our reference.

[False Positive Anti-D in Gel?]

Upon subsequent recollect, she is still weakly positive (1+) in gel, but negative in the tubes although her weak D is a +/= reaction. My thoughts are in line with Malcolm and we will consider her a D negative for Rhogam purposes.

[False Positive Anti-D in Gel?]

This past March we had a patient come thru the Emergency Department who was pregnant and spotting. A Type and Rh were performed at that time with a result of O Negative using the conventional tube system. She is now back in the facility delivering but testing as O Positive in the Gel system, but still typeing as O Negative in tubes. What is could possilby be the problem, and what can I do to not see this problem in the future?