[ABO Discrepancies???]

Rouleaux or a strong anti M?

[Time limit for type and screens on outpatients]

We do the same. We extend our specimen 3 days after the actual day of surgery if:

1. NO.. recent tx (3 months prior)

2. NO pregnancy (recent or last 3 months)

3. No hx of Positive IAT, or antibodies..

Can you explain #3? I would think you would want to include these patients.

R1R2

[bed side blood group verification]

We perform a bedside confirmatory type with each "start" of a transfusion at my facility. We have special Blood Bank staff called "Blood Bank Assistants" that take the blood to the floor and start the transfusion with the patient's nurse. We do not use a special kit. We merely take a small tray of supplies and perform a slide type on either a fingerstick specimen or a specimen drawn from the patient's line. This is performed BEFORE the start of the blood or blood product. We perform this bedside type each transfusion unless there is product hanging with which we can compare blood types and patient information. As a result, we do not have ABO hemolytic transfusion reactions. This bedside type is even performed in surgery using a small amount of blood from the line tip. This is acceptable with all regulating agencies, including FDA as we are FDA inspected). The last AABB inspection we had was so impressed that I was told that they would try to make it a recommendation.

How do you record the results of this bedside test?

[Platelet pH Testing]

I thought pH testing of platelets was no longer acceptable?

[30 minutes for return blood and blood products]

For those of you that state that blood must by completed within 4 hours of issue -> how do you handle units issued to patient care areas with remote storage (OR, SICU)?

[Positive DAT on Cord blood intefering with weak D test]

Does anyone try to remove bound antibody to get an accurate D type?

R1R2

[Fresh platelets for actively bleeding patients?]

Our ICU director says that she notices that actively bleeding patients have minimal post-transfusion platelet count increases with platelets that are nearing their expiration date compared with platelets that are fresher. She would like for us to issue fresher units to actively bleeding patients. Obviously, platelet inventory management is a huge problem and we like to have the best use of our inventory so I would like some proof to support her position before I would institute a policy that might increase our platelet wastage. Do any of you know of any studies that specifically deal with platelet refractoriness as a function of platelet storage time in actively bleeding patients?

Can your ICU director provide you with data she collected? Did she look at the blood types issued and patient blood types? I have been asked for fresher platelets for oncology patients, never for actively bleeding patients.

[Transfusion policy OMG!]

We have no policy in place that states a patient can't walk around with blood hanging. The transfusionist does instruct the patient on signs and symptoms of a transfusion reaction and that the patient should inform the transfusionist if necessary. I am not too concerned about this. If this problem only applies to one patient instruct him to stay put and document the conversation. You can only do so much.

[Wireless temperature monitoring]

Hi everyone,

Is anyone using Sensoscientific or Sensotech to monitor blood storage equipment?

[Passive Anti-D in Capture-R Ready method]

Well, from that point-of-view, I doubt if the passive anti-D will cause too many problems, and I wouldn't worry two hoots about not detecting antibodies of those specificities (in fact, I wish we didn't!!!!!!!!!).

If you think about it, there are an incredible number of D Positive babies that have been born to D Negative Mums, where the Mum has received prophylactic anti-D immunoglobulin (sometimes in quite large doses) where the baby has not suffered any clinically significant sequalae, even though their own D Positive red cells are sensitised by the passive anti-D. Most of this passive anti-D will have been "mopped up" by their own D Positive red cells, and so there will be very little passive anti-D left to cause any problems if donor D Positive red cells are transfused to the baby. This, of course, is quite a different situation to where the mother has produced a cracking alloanti-D of her own, where there certainly would be clinically significant sequalae, should D Positive donor blood be transfused to the baby.

I agree with Malcolm. In fact, I don't think I have ever seen an Rh positive baby with passive anti-D in plasma (DAT positive only).

R1R2

[Helmer Freezer Validation]

That's what I thought as well - and if it is, does anyone have a suggestion as to how I achieve this without using real plasma (in case it fails)

If you want to validate that the freezer can circulate cold air when filled with plasma you can use anything to fill the freezer, such as bags of water or saline.

[Helmer Freezer Validation]

I thought that temperature mapping was part of validation?

Not that I know of (in the US). Perhaps someone else knows differently?

[Helmer Freezer Validation]

Really? I come from a hospital that does a freezer validation empty and then also loads it with frozen recovered plasm s and monitors the temperature for 24 hours - mimicing the presence of real plasma. I am glad I am asking this question I would love to hear from others as well

Thanks R1R2

Perhaps you are thinking about temperature mapping?

[Helmer Freezer Validation]

I have never used plasma to validate a freezer. I have validated that alarms work, temp is accurate, plugged into proper receptacle, chart works, door seals properly, unit maintains temp etc.

[30 minutes for return blood and blood products]

It is relatively inexpensive and if you are able to return just a couple of units back into inventory per year it pays for itself. It is easy to validate, use and recalibrate.

[File for patient cards]

You should be able to determine if patient has blood available by accessing the computer file and do away with the cards. You may need a s file to keep transfusionadministration record paperwork if you need to tag units ahead of time. We havecompletely removed all paper files due to some unfortunate clerical errors. Wecrossmatch on demand, but if we have to tag units a head of time the paperworkis kept with the unit in the fridge. We access the patient's computer file todetermine if patient has blood available.

[Not issued in the LIS]

I agree with Mabel. Keep documenting like David said. But then trend it to see, If you have multiple techs doing same error, may be you need to look at your process and make the process such that you do not allow for the blood go out without issuing blood in LIS.

1) Do not keep printed crossmatch/component tag.

2) Allow them to print only at the time of issue.

after trending we changed our process completly, invested in new printer for crossmatch/component sticker. changed the process so transfusion tag prints at the time of issue with the issue date and time on it.

We hardly have any error, once/twice a year and that even during system downtime only. In that case we give a benefit of doubt and just remind the staff to complete the transaction after systme is up.

We have zero tolerance for all other cases due to carelessness.

Thank you aakupaku for your ideas. We have institued your suggestions several months ago and they have helped. Our last error occured because tags were printed out ahead of time because of special patient requirements. I am looking for zero errors. Perhaps that is not possible?

R1R1

[Not issued in the LIS]

Hi everyone,

Please tell me how you solved your "not issued in the LIS" problem. Thanks for your replies.

R1R2

[Standalone Blood Bank Data Backup System - is there one?]

What kind of reports are you printing? Daily, weekly? How many pages?

R1R2

[Consolidating reagents]

Thanks guys. I will tell the techs not to do it in front of an inspector.

[Consolidating reagents]

Does anyone know of any regulations prohibiting consolidating a reagent of the same lot and expiration date is not an issue?

Thanks for your replies,

R1R2

[Another FDA reportable question]

No, it is not reportable.

R1R2

[Rapid Emergency Evacuation of the Blood Bank]

We have written in our SOP that if time allows and employee safety is not an issue a cooler may be packed. If time does not allow or safety is an issue employees leave without blood. We also have a designated cooler for evacuation to place blood products. It is stocked with necessary logs, phone numbers, pens, bags, etc to take in an evacuation. We do not stipulate that blood products must be packed properly as they would not be returned to inventory. We would call supplier for additional stock as soon as we relocate. We have designated relocation areas. We occasionally conduct in services to review process and procedure.

[Patient attributes]

I have SoftBank (with Epic as my HIS). When a physician orders irradiated or CMV neg, it adds an "action" to the order so that the tech is sure to give that product. But if we want it attached to that patient permanently, the tech still has to go in and add that patient attribute in the admin file. Not sure if I would want that automatic since we have so many physicians that order these when not needed.

Hi Terri,

Can you explain more about this "action"?

R1R2

[Saline incubation...why is this SOP still allowed?]

We are a CAP accredited lab and 2x year we compare all our testing methods. We compare gel, LISS, PEG, saline techniques. All methods have detected all clinically significant antibodies.

R1R2