R1R2

My pet peeve is the placement of labels - nursing will not cover the attached label on the tube so you get a specimen where you cannot see the plasma/cell interface.  Regardless of how many times we educate on this it refuses improve.

If you are Joint Commission accredited in your lab, this is no longer a problem.  Joint has a standard QSA.05.18.01 that states specifically "The requirement that suspected transfusion related adverse events are reported immendiately to the lab, whether or not the the physician responsible for the patient deems it necessary to report the event."
 
This changed what we do to: if we hear about it - it gets worked up.  (that's if my team member remembers the change!!!)
 
I have attached our old paperwork for the Transfusion Reaction Workup Request and the Transfusion Reaction Workup.  Feel free to use what might help you.  We are still struggling to get this in Meditech - tried to make it too fancy and have finally decided to back down to simple T-Tests, but now don't have the time to build them with my IT Coor. (Oh well!)
Suspected Transfusion Reaction Workup 742-002.pdf
Suspected Transfusion Reaction Workup Request 742-001.pdf

LOL...not usually. They just want me to point to where they sign. Then the couple times a patient has had a hemolytic reaction due to an undetected alloantibody, they say "wait...didn't I ask you for O Neg? That has nothing on it!". {{{heavy sigh}}}

Not quite sure what the DAT is adding to the mix.   I could see if you are using AHG antisera but even then, the negative control would not be negative.   A positive DAT may also interfere with RT antisera (rare but possible) but then again, the negative control would not be negative. If controls work you should be good to go. 

I searched a CLIA site and found this from the following site:
 
 
State Operations Manual
Appendix C - Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services
Table of Contents
(Rev. 140, 05-29-15)
 
(493.1271)
There generally are no daily quality control requirements for reagent red cell panels used in antibody identification. However, we encourage laboratories to follow the manufacturer’s recommendations for QC.
 
I printed this part so if an inspector tries to to say I HAVE to do QC I can show this. I think the red was what was revised in May 2015. I want to do what is good for the patient but I don't want to go overboard and use up all my panel cells trying to satisfy a nebulous requirement.
 
I use Immucor and the manufacturer's insert says "the reactivity may be checked periodically with a weakly reactive antibody." (??) MAY doesn't mean the same as HAVE TO. We get hung up on every word of standards, why not the package insert too?  After reading what Dr. Pepper wrote when he talked to CAP, I included a column on on our antigen typing form to add the panel lot # since we use panel cells for antigen controls. They should work as expected to show the panel is QC'd multiple times weekly. (Thank you Dr. Pepper, it was an easy fix)

Semantics are very important. May is optional. Should is equivocal. Must is a requirement.
 
I'm still trying to weed through several old procedures that have inappropriate uses of 'may'/'should' when they're really 'must'.

No I don't think it is harsh.   I often wonder about hospitals validating reagents/tests off label becuase I don't think they even come close to the numbers/types of specimens that the manufacturer uses to validate and submit to FDA.  This is just my opinion.   I caution anyone using reagents for purposes other than those intended by the manufacturer. 

No I don't think it is harsh.   I often wonder about hospitals validating reagents/tests off label becuase I don't think they even come close to the numbers/types of specimens that the manufacturer uses to validate and submit to FDA.  This is just my opinion.   I caution anyone using reagents for purposes other than those intended by the manufacturer. 

I agree that it was odd. I would give the blood and ask questions later or better yet have your medical director or manager get involved. If you never get a sample and no more blood is required you should document appropriately and move on.

I agree that it was odd. I would give the blood and ask questions later or better yet have your medical director or manager get involved. If you never get a sample and no more blood is required you should document appropriately and move on.

I agree that it was odd. I would give the blood and ask questions later or better yet have your medical director or manager get involved. If you never get a sample and no more blood is required you should document appropriately and move on.

I agree that it was odd. I would give the blood and ask questions later or better yet have your medical director or manager get involved. If you never get a sample and no more blood is required you should document appropriately and move on.

I agree that it was odd. I would give the blood and ask questions later or better yet have your medical director or manager get involved. If you never get a sample and no more blood is required you should document appropriately and move on.

I agree that it was odd. I would give the blood and ask questions later or better yet have your medical director or manager get involved. If you never get a sample and no more blood is required you should document appropriately and move on.

In our policy it states to consult with medical director.  For a small amount, like what is in an Rh positive platelet product, administration of RHIG is simple solution and usually safe.   For larger volumes of Rh positive cells, like a whole unit of blood or more, administration of a large amount of RHIG can produce a transfusion reaction-like situation.  Like John said,   formation of anti D is not an automatic kiss of death.  

In our policy it states to consult with medical director.  For a small amount, like what is in an Rh positive platelet product, administration of RHIG is simple solution and usually safe.   For larger volumes of Rh positive cells, like a whole unit of blood or more, administration of a large amount of RHIG can produce a transfusion reaction-like situation.  Like John said,   formation of anti D is not an automatic kiss of death.  

Not quite sure what the DAT is adding to the mix.   I could see if you are using AHG antisera but even then, the negative control would not be negative.   A positive DAT may also interfere with RT antisera (rare but possible) but then again, the negative control would not be negative. If controls work you should be good to go. 

Not quite sure what the DAT is adding to the mix.   I could see if you are using AHG antisera but even then, the negative control would not be negative.   A positive DAT may also interfere with RT antisera (rare but possible) but then again, the negative control would not be negative. If controls work you should be good to go. 

We do not pool them, but rather have nursing do it when they start the transfusion.  This avoids the issue all together.

When we pooled them together, we changed the date to 24 hours.  We also lost the ability to return them to the supplier if they ended up not getting transfused.
 
We no longer pool them together.

I understand your concern and would first want to identify a cold by running appropriate tests before jumping right to prewarm and assuming that because reactions went away that it was due to a cold.  Many years ago when I was a new supervisor, I observed exactly what you described and was bothered by it.   I reviewed past workups that were identified as cold abs and found that many were really wishy washy anti M's.   I did find one Fya  that was reacting sporadically with only double dose cells.   The way they performed antibody id was quickly changed to stop the practice of prewarming away unexplained reactions. 

Even in cerner classic you could issue to dummy patient. We used to have -------------- for patient name on the tag for the uncrossmatch units we kept in ER & OR refrigerator because we were issuing units to dummy patient to print the tag with all the information and then we would returned them in the system so they would be available. 
My tech loved it compare to what they had to do when they were all writing manually...

We have changed from clear ziplocks to insulated lunch bags. We place a small gelpak (not frozen) in with the unit. If the unit is returned to us, we check the temp as we always have. Only now the temp stays almost identical to the temp when removed from the fridge.

If the paperwork/unit tag that was attached to the unit, the one the nurses double-check before they transfuse it (usually) did not match the actually unit, then yes, it is reportable. 
Switched tags, even if it's the correct patient, but the wrong unit, is a reportable event. 
And everyone else is correct - the FDA doesn't swoop in!  But when/if they do come, they will want to see your corrective actions, if needed. 
Last FDA inspector here (2014) informed me that they are looking at computer systems, since most places bypass their computers for emergencies. 

Be careful with the reagent anti Ms out there.   Some only require a RT incubation with no centrifugation before reading.   I have found that centrifugation may cause false positives.   Read those package inserts!