MAGNUM

New account number, new visit, new type and screen.

New account number, new visit, new type and screen.

When I do an antigen typing on a patient that also has a crossmatch, I crossmatch the units at the same time as I do my Antigen typing

If the parent blood unit comes to you with the pedi bags attached, and you are just sealing them off (whether heat sealer or hand sealer clips) - AS LONG AS THERE IS NO VENTING AND YOUR SEALS ARE ALL TIGHT - you would retain the parent outdate. 
I imagine the pedi bags are connected to the parent with a sterile connecting device. 
So you're good to go!

everyone should think about how important this is, rechecks and everything. case in effect the nurse in the London Heart Hospital whose patient died because of a unit of incompatible packed cells.

same here Malcolm

An excellent post JHH1999, however, if I made the cake today, with milk that had a use by date of tomorrow, there would be grave doubt as to whether the cake would be edible today, let alone in a few days time!!!!!!!!!!!!!

Yes. Without the stir ball the Echo is sampling a reduced number of indicator red cells/more diluent. The longer the vial is on the instrument without the stir ball, the more settled the red cells become and fewer and fewer of them are sampled/added to the test well. In the package insert for the indicator cells under Limitations: "Addition of too few indicator cells, as might occur with improper mixing of the reagent or through hemolysis of red cells, will cause weak falsely positive results." The vial should be discarded and a new vial with a stir ball loaded on the instrument before performing any additional testing. You'll see funky results with A and B cells missing the stir ball, too. Those vials should also be discarded and replaced with new vials/stir ball added.

This subject came up recently at our facility and it was decided by our Patient Safety Committee, of which I am a member, that the co-signer would need to be qualified to administer blood.  This means, RNs, Perfusionists and Anesthesiologists.  The thought process was that if the co-signer is not qualified to administer blood, then they would not be knowledgeable enough to know exactly what they were verifying.

Same here as Jeanne. I order a "baby unit" from our supplier, and they sterile dock 6 aliquot bags to the mother unit. If I find that I will not be using the unit for babies, at 14 days I remove the aliquot bags and transfer it to my stock to be used for adults.

I agree, BUT, if the antibody identified in the previous sample has, for example, a specificity of anti-E, and you titrate using r"r red cells and get a titre of, for example, 64, and then the next sample gives a titre of 4, what do you do?  At this stage, you have no idea whether the original titre of 64, or this titre of 4, is correct.  It could be that there is a second specificity present (say an anti-Swa) and it just so happened that the original r"r red cells also expressed the Swa antigen.  Now, I will readily admit that both anti-Swa and the antigen Swa are exceedingly rare, so these were probably not a great example, but, supposing it was an anti-E and an anti-Kpa?

Anti-ce is a so-called compound antibody (and is also known as anti-f).  It is an antibody that will only react with red cells that are derived from an individual who has the RHCE:ce gene, or, to put it more simply, it is an antibody that will only react with red cells that express both the c and the e antigens derived from the same haplotype (i.e. in the cis position), rather than derived from different haplotypes (i.e. in the trans position).  So, for example, the anti-ce will react with red cells that are DCE/dce (Rzr), but will not react with red cells that are DCe/DcE (R1R2).  It is actually usually made by an individual with the R1R2 phenotype (or probable genotype).  It is of fairly doubtful clinical significance (BUT, NEVER trust an Rh antibody).
Anti-hrS, usually seen in individuals of Black ethnicity (who have an e variant, but who have been exposed to a "normal e antigen through pregnancy or transfusion - or both!), mimics an anti-ce.

Well, think about this... the indicator cells are rosetting any cell with IgM coating it  - test uses a monoclonal IgM anti-D.  But anything else that's IgM coating the cells may give you pos test. 
You cannot tell with certainty using this test the Rh of the baby.  Certainly it's not the test of record.  If you ever had to defend your result, you'd have difficulty. 
Picture this:  you've presumed the baby is Rh neg based on the FMH screen.  No RhIG for mom.  Baby is really Rh pos (variant?), and mom goes on to develop an anti-D.  Next baby is at risk.  Mom sues.  You have no defense, as this is not standard practice. 
In the case of a pos DAT with an inconclusive Du, we do a KB and presume the baby is Rh pos.  RhIG dose based on the KB.

Without a doubt I would send it for KB, because the operative word in the limitations is "may" - they are not always destroyed.  In addition, even if the delivery was an uncomplicated PV, that does not rule out that there may have been a major, but silent FMH that requires a larger dose of anti-D immunoglobulin than your standard dose.

Yes, as there are times when the causative antibody is an IgM (such as anti-Vel), and, never forget, the titre of the anti-Vel may be VERY low, but the complEment system is an amplification system (i.e. one C1qrs complex will result in huge numbers of other activated complement molecules further down the line), but you can concentrate the eluate and be able to detect the antibody originally sensitising the red cells.  The antibody can also be a VERY weak IgG antibody (IgG1 or IgG3, or a mixture), and the same applies.

CONGRATULATIONS on your retirement. But at least we still have your wealth of knowledge to impart upon us.

Do you have a way of listing patients from your system who had incompatible crossmatches with antigen-negative units antigen-untyped units in the presence of a negative antibody screen?
Are you asking about patients whose current antibody screen is negative but have a history of antibody?  If so, the following antibodies are configured as clinically insignificant in our Meditech system when then allows electronic crossmatch: -Lea, -Leb, -M, -N, -P1, COLD, WARM, NAD, INC, -RhiG. 
In response to Malcom and on an individual basis, you could create an anti-M (M37)  that is clinically significant and an anti-M (M) that is clinically insignificant.

In addition to the 20 samples, if you are not able to find weak positives, you can make your own weak positives. Just Google it.

We work them ALL up! If the patient has a reaction either immediate or delayed we work them up. We took the thought process out of the picture for the nurses, if they suspect a reaction (and we do provide them with a chart of reactions and how they may present) they order it. They can call the patient's physician, but we wrote it into our policy and had it approved by our MEC to order it if they feel a reaction is happening.

We work them ALL up! If the patient has a reaction either immediate or delayed we work them up. We took the thought process out of the picture for the nurses, if they suspect a reaction (and we do provide them with a chart of reactions and how they may present) they order it. They can call the patient's physician, but we wrote it into our policy and had it approved by our MEC to order it if they feel a reaction is happening.

My facility wanted the lab to use the same document control setup as everyone else in the place - same template for SOPs, same review timeline (not often enough for lab previously), same drive location as all other SOPs and available to all users, etc. (Why the rest of the hospital would want to read an SOP on how to do maintenance on an Echo or how to do a test on a Dimension, I don't really know.) We were able to show them that we were already using document control and had been for a very long time, that their template did not follow the style that we felt we needed to follow for our SOPs for regulatory reasons without doing some strange things to our procedures and that we had been reviewing our SOPs regularly and frequently for many many years. They allowed us to keep on doing what we were doing with the exception of SOPs that needed to be available for general hospital use, of which there are not a large number. 
One interesting thing that did come out of this discussion was the use of references, specifically the use of the edition and date of the reference. I told them that Blood Bank had been using 'current edition' for some time and that it was an AABB commended practice when I started doing that. They were not budging for quite awhile until I could get them to understand that there are specific dates when the Standards, for example, come into force, that new Standards are published pretty frequently, and that I could come up with those dates after the fact. I explained to them that what we do follows those standards - when the standards change, so do our SOPs. Ditto for CAP standards. Another thing that was discussed was referencing somebody else's procedure as one of your references. Nursing protocols apparently commonly use Such and Such Hospital, v #, date whatever, borrowing protocols from other facilities and then using that protocol as a reference. I had to explain that lab doesn't work that way - we have protocols based on manufacturers requirements, standards and book references for the most part, not what the neighbor does (with exceptions).
In the end, the agreement was that lab would continue doing what we were doing - they came to realize that we were doing a good job with document control and had been since dirt was invented. We could continue using our templates for SOPs unless the document needed to be part of the hospital manual. If that was the case, then we needed to follow the hospital template and follow the same format for references, including edition and publication date. In Blood Bank I have a few procedures that I share with surgery regarding bone and tissues, so that is one area where I do it their way. They feel very strongly about edition/date, stating Joint Commission as the reason. I have not seen the standard that would require it, but I am abiding by the game plan.
 

NO!! Mutiny would ensue should we require they be worn at all times.  Lab coats, gloves, yes, but not shields.

NO!! Mutiny would ensue should we require they be worn at all times.  Lab coats, gloves, yes, but not shields.

NO!! Mutiny would ensue should we require they be worn at all times.  Lab coats, gloves, yes, but not shields.

We've been converting FFP to TP directly for some time now.  All of our thawed units start with a 5-day outdate.
 
Scott