R1R2

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!

If you attend any Medicare billing conferences they discuss this in detail.  You can only charge for an antigen typing to one patient.  Now if you want to charge it to the patient you initially screened  OR the patient that is receiving it if the first didn't need it that is fine, but charging bothing for something you have done once is a mischarge.  At least that is how it is discribed.

I have not found any standard or checklist item that requires daily readings of graph/digital/thermometer to agree within any variance.   As long as all temp readings are acceptable then you are good to go.  Quarterly, all temps are compared and should agree within +/- 1 C.

on the very very very very rare occasion I have to transfuse a neonate prior to transport - they get the entire bag.  I will not make a procedure for something that happens once every 20 yrs.  I don't even want to think about my staff's competencies let alone the Nursing staff.  I think I've only given some thawed plasma once in the last 22 yrs here. 

My pleasure; it's my hobby, for which I get paid - but PLEASE don't tell my employers, or else they may STOP paying me!

I always read that standard that panels needed to be kept forever, but someone just pointed out to me that you have to keep the results of antibody ID indefinitely, but not necessarily the work it took to get there.  So, if you have a record that says "anti-Fya", that needs to stay indefinitely, but the panel that led you there only needs to be kept for 10 years.

Found it!
Antigen_specificity_and_blood_selection1.docx

Auntie-D, I certainly didn't set out to insult anyone.  I was simply commenting from my experiences and those I have heard from others.  The tone of your response was certainly accusatory.  One of the things I appreciate most about this site is the openess of the members and I hope it stays that way to encourage conversation.
 
Confirmation bias does not mean that someone was intentionally careless, it is often subconsious.  There is also plenty of use for 2nd checks (we use several), but it should not always be the answer without an investigation of the process.  Unnecessary checks can bog down a process, add cost and time, and sometimes not even add to the safety/accuracy of the process.  

No new standard that I know of. I would drop this practice. 

Nooooo it's a robin with sunglasses waving hi...

I appointed a lab associate to "reagent czar" after too many incidents of no indate antisera available.  He checks the fridge regularly and knows when rare antisera is expiring and orders more when necessary. 

We have transitioned to using group A FFP and liquid plasma for our trauma patients who are emergency released blood, and for all MTPs (we still use AB if we have an abundance of it thawed or if we are only able to get AB liquids to restock). My supervisor worked with the trauma program medical director and the CMO and we developed new SOPs for this. We have discussed putting together a short paper, as we've been collecting data on all emergency release patients. Since September we've had about 40 trauma patients receive group A plasma, and we've only had three B/AB patients in that group. On each of these patients we ran some extra post-transfusion labs (renal panel and LDH, DAT), nothing really notable so far. We've also been doing an abbreviated titer on the liquid plasma units we receive and setting aside anything with a titer of 64 or greater (only about 10%) for use on A or O patients only, if possible (which is most patients anyway!). FFP is not titered.
 
So far we've had no problems and it's been much less stressful than trying to restock AB after multiple traumas. In fact we had a day last month where we had 7 bleeding traumas in one shift, we would have been in a pickle if we'd used AB for them, so it was a huge help.

Our techs only do the clerical check and unit/tubing inspection on reaction investigations for non-RBC components, they will send the product for a culture if directed to by our medical directors, but the medical directors do the investigation to determine if TACO or TRALI or some other non-hemolytic reaction occurred.  
 
AABB is pretty vague, just states that you have to have a policy.  And CAP requires post-transfusion DAT and ABO on potential hemolytic transfusion reaction investigations.  So, I suppose if you thought you had a hemolytic reaction involving a non-RBC product, then you would have to get a post-transfusion specimen.

I appointed a lab associate to "reagent czar" after too many incidents of no indate antisera available.  He checks the fridge regularly and knows when rare antisera is expiring and orders more when necessary. 

I appointed a lab associate to "reagent czar" after too many incidents of no indate antisera available.  He checks the fridge regularly and knows when rare antisera is expiring and orders more when necessary. 

Ours were very simple.  Come to work when scheduled and do the best job they could.  Any other goals they came up with on their own.  I rarely if ever assigned goals for my staff but helped them achieve any they chose to tackle.

We use the Ortho panel with the @ symbols with no problems.  Here's why I don't care so much that it doesn't rule out everything with a double dose/homozygous expression:
 
Passive Anti-D isn't really an "antibody" as far as our rule out "rules" go.  We have information that the patient received the RhIg, which confirms the reactions in the screen.
 
If we detect an antibody, we are mostly concerned with identifying it.  If they have a history of antibodies, we are mostly concerned with looking for new ones.  With an "interference", like a RhIg or non-clinically significant cold agglutinin, we are just trying to get it to go away.
 
If you look at your screening cells, we are ruling out with single dose cells every single day.  So I look at the @ cells as a screen of D negative cells.  I'm not really considering them rule outs in the true sense.

I called the CAP about a year ago and I was told that this does not apply to Blood Bank reagents.  Whoever I talked to at CAP said that the question would be revised.  I have never been cited for not doing this.  Has anyone else called them to ask the question?

I totally agree with you, DebbieL!!
 
Donna

I agree with everything Ann stated above.  The only real problem is that the unit was disconnected, and removed from the patient.  Everything else that was unacceptable occurred after that.  Obviously, at this late date, there is nothing you can really do but consider this a wonderful opportunity to educate a few nurses.  Good luck with that! 

Taking a guess, Fetal Maternal Screening???
 
Typically the fetal testing serology readily differtiates the sample for from maternal, e.g. the DAT is typically strongly positive when the Mom is allo-immunized.  We would do a Kleihuer-Betke stain if the fetal cells don't test as expected.

Has this patient received IVIG or something similar?

I hope you were wearing ample PPE when you read that answer!!! 

We do nothing on the mom except the fetal screen test.  If it is grossly or diffusely positive, we will do a weak D test on the mom to see if the Fetal Screen is positive due to a weak D antigen.  We will usually have done the mom's prenatal testing.  
 
I have often wondered why we would check the Rh on the mom we are doing the Fetal Screen on.  If we have her type wrong we will know it when her Fetal Screen comes off positive macroscopically.  All the moms that were determined once early in pregnancy to be Rh positive are the ones at risk if there was a mix-up in that original type and they are really Rh neg.  Those sites that do a blood type on all OB admissions have this covered of course.

I am insanely jealous - I keep trying to get one of those but it is futile.  That is the way fetal bleed calculations should be done.