R1R2

Do you have a transfusion committee?  If so, they might be a good one to bring this to their attention.  Also, if possible you might want to check, if you computer system is capable, and see if it is a generalized problem in ER or if you can pinpoint it to select physicians.  Another suggestion would be to get your medical director involved, it always seems to go a little smoother if you can get doctor talking to doctor.  In this day and age doing unwarranted testing should not be the norm and I imagine it will be very difficult to get some one to pay for a T&S on a diagnosis of "insecet bite".

you may want to see if you can detect mixed field in other typings such as C, E, c  to add to the idea of possible contamination with mom;s blood.

On second thought, if administration of  RHIG is not an issue (mom is Rh pos correct?), why not call the baby Rh neg? 

you may want to see if you can detect mixed field in other typings such as C, E, c  to add to the idea of possible contamination with mom;s blood.

And why does ruling out with 3 single-dose cells improve your odds over using 2 or even 1?  It doesn't make the antigen on one cell stronger because you ran two others. I know there is a chance that 1 cell has a weaker antigen so running 2 means that you have a better chance that at least one cell will pick it up.  I still think the places that require 3 rule out cells have the rule of 3 for identifying an antibody mixed up with what it takes to rule out.  Have I ranted on this before maybe?  

you may want to see if you can detect mixed field in other typings such as C, E, c  to add to the idea of possible contamination with mom;s blood.

We compare all thermometers/probes to NIST once a year and they should agree +/- 1 C.   Once in the fridge (or other equipment), there is no requirement that they must all agree to others within +/- X degrees.  
 
To synderci - you can probably get rid of your top and bottom bottle thermometers if your fridge probe compares favorably to NIST.

You will still need to keep a segment.  Maybe you could keep them in a bag instead of keeping it with the patient sample.   

I don't think there is a best practice.   I have seen it work using either syringe or bag, although I have had problems with syringes leaking during transport.   

Hi Miguel,
 
We use Sensoscientific and have found that, for the type of set up we have, the temp is only sampled once every 10-15 minutes and that an additional 10-15 minutes may pass before we receive an alarm.   Because of this, we could not use the system for notification of blood storage equipment alarms and we kept the equipment alarms active.   We only use the system for recording temperature. 

May be just list the non conformances so other facility can get ideas of what are the possible NC.
Recently there was one non conformance which was very useful to many other facilities. (Derivative storage with blood products/at 1-6C)

I would also suggest you run your old system in parallel with the new system for a few months to identify any issues.   

What do you do for other send out tests?   Somewhere, somehow agreements have been made with these facilities, mostly for billing purposes though.  Maybe look at it from that angle.

I think pre-warm testing got it's bad reputation because in the 'old days', when we were running antibody screens that included the IS/22C phases and used polyspecific AHG, if the test was positive at AHG and also at room temp, we would rerun the AHG phase using 'Prewarm Technique' to see if we were seeing a complement fixation due to cold agglutinins or a real IgG antibody. 
 
In those days, Prewarm Technique meant using NO enhancement; albumin wasn't allowed because it was said to enhance complement uptake, which is what we were trying to avoid.  The change from Albumin to 'nothing' lowered IgG uptake, hence the sensitivity ... so yes, of course we were risking losing sight of clinically signficant warm antibodies.
 
The world has changed since then ... we don't use polyspecific AHG anymore, most places don't test at room temperature anymore and prewarming is merely just that - same test only at 37C before you mix plasma with cells.
 
In fact, if using automation (e.g. ProVue), the antibody screens are all pretty much prewarmed because they are sitting in the 37C incubator for at least a few minutes prior to adding plasma/reagents.  So, we are testing 'prewarm' by the thousands daily ... and nobody is fearful about missing antibodies due to prewarming.
 
Prewarming is no longer 'lowering sensitivity' if that is the only parameter that is changed.
 
I agree ... this hospital you cited was mistaken and hopefully has corrected their workup plan:  'Prewarming' away an antibody that is clinically signficant is a strange policy ... similar to 'just shake it harder' or 'repeat until negative'.  HOW were they 'prewarming'?  Were they using the old 'Prewarm Technique'?
 
And yes, thank you for stressing ... we, too, have seen plenty of antibodies that react with ONLY homozygous cells, even in gel. (So please no talk out there about 'eliminating with 3 heterozygous').  
 
And I agree with 'look at what positives have in common' ... we found that PEG will demonstrate a nicer Anti-Jka than gel sometimes, so if you get a hint of Kidd ... or a hint of anything significant, try PEG. 
 
More evidence that we have to carry a 'toolbox', not depend on one reagent/platform/technique. 
 
And that we cannot take all the old 'rules' and apply them to all the new processes.

In my experience, most of these babies are truly Rh negative.   I think cost  and time are major reasons for resolution for positve DAT when weak D typing needs to be performed.   KB is expensive and time consuming.   Each vial of RHIG is >$400.   EGA treatment is less than $100 and takes just a few minutes.   I like the mild heat elution method too

I agree with Pavel and thank goodness most of us have computer systems that would not allow #1. 

I like your last sentence!

I have only ever stocked the large dose of RhIg - why risk giving the smaller dose. The cost is the same (for me anyway) so I'm not harming the pt/mother in anyway with the larger dose (300ug)regardless of gestational age. As I stated above - the KB stain looks for fetal cells; the docs want to see if the placental circulation is compromised. Forget the rosette. (and I forget the samller dose; the docs have no choice in the mattter and I have never had a problem in a 700+ bed tertiary care hosp with busy ED and neonatal unit; a 350+ bed with busy maternity/ED; and a small 24 bed with busy Maternity/ED). Give the docs what they need 'cuz they are not always correct in what they want.

You should have a process in place to monitor temps of units sent to the OR and then returned to you if you plan on returning them back into inventory,  i.e. Safe-T-Vues

Ask the administrators who make these kind of decisions: which 0% performer would you like doing your mother's type and screen?

Some suggestions:
Time/attendance record
Errors, or corrected reports
Work in multiple departments
Willingness to stay late, take extra shifts
Willingness to help others when work is caught up
Positive attitude, discourages negative talk in coworkers
Turn around time (managing workflow effectively)
Mentor to coworkers, helps train students or new staff
Pursuing advanced education
Critical thinking skills

We do this all the time Eagle Eye (something in CAT, nothing in tube and cross-match by tube) and have had NO problems whatsoever for well over a decade (and we are a Reference Laboratory). I say again, something that I have posted many times, there were no more patients killed by either AHTR or DHTR in the old days, when we only had tube techniques, than are killed now that we have all these other more sensitive techniques. The only difference is that we now detect a lot more antibodies that (theoretically) are clinically significant, but (practically) are not.

Thanks Malcolm! Paranoia and comfort levels are understandable (all Blood Bankers should have a healthy dose of those), but you have to balance it with the science (what methods you have available to you) with the need for transfusion of the patient.

This thread terrifies me...

Good luck to you Sophie1210.
You've got a good boss their too!