cbaldwin

Has anyone been recently surveyed by the Joint Commission? We are expecting a survey in May, I am preparing for it, and I wondered if there were any trends this year in what they are “observing”. I am responsible for a small transfusion service in a 26 bed rural hospital. I am checking that documentation for reagents, QC, competency, training, proficiency testing, and patient testing is complete. I’m updating my P/Ps, and going over the QSAs. The Joint’s observations in 2017: 1. Not labeling uncrossmatched O negative units with patient’s name, DOB and MRN during traumas. (QSA.05.10.01) 2. Not periodically reviewing with our medical staff information regarding our BB inventory. (QSA 05.02.01) (The inspector explained that a new physician unfamiliar with our BB inventory could start a procedure that required more products than we have. The procedure could fail because of inadequate blood products, resulting in possible patient death and legal action) 3. Not always having the time of signature on transfusion consent forms— “in 3 of 3 consents for transfusion documents reviewed, the time of the patient consent had not been recorded.” (QSA.05.17.01) 4. Not readjusting the set point to simulate a high alarm when doing quarterly checks on our plasma thawer alarm. Biomed was checking the alarm, but not simulating a high alarm as the manufacturer requires. (DC.02.04.03) Around the time of the 2017 survey I remember others on BB Talk mentioning that they were cited for not labeling Uncrossmatched O negative units. That observation caught me by surprise. My reactions to the other observations were…well, I should have known better. We have a lot of traveling MDs and communicating with them regarding our inventory is very important. And I should have read the plasma thawer operator’s manual more carefully. I’m just wondering if surveyors are concentrating on anything in particular this year…. Thanks! Catherine

So now you have an exciting hobby?

Just found out...our reference lab charges $305. Thanks all for your replies...I am learning...have a lot to learn. Catherine

Thank you for this information. I just found the handouts from a lecture Sue Johnson gave in March 2016 at an Immucor Users meeting and I have attached them in case anyone is interested. It's very good. She discusses the molecular basis of weak D and partial D and the variability of reagents and methodology, also the recent recommendations of the Inter-organizational Work Group on RHD genotyping for managing pregnant women and transfusion recipients who have a serologic weak D phenotype. On page 18 she states that there is a new CPT code 81403 for RHD genotyping (Tier 2 molecular pathology procedure, Level 4) and that reimbursement rates for the Tier 2 code are being established. Also that the ACOG is updating its Practice Bulletin to recommend molecular testing. I just got a new phone number to call to see if I can get the price that we will be charged if we request this test. My OBGYN physicians would like to know. Catherine Johnson Handouts.pdf

Thank you! This is good information. I will call our Immucor rep. Catherine

I am working with our OB/GYN MDs on how we will handle weak D OB patients. First of all, we would like to know how available the test is and how expensive it is. When I contacted our IRL to inquire about the price of this test, which they list on their menu, I can only speak with technical people who know nothing about billing, and I do not expect them to--I am a technical person and I know nothing about billing. They did tell me they send the test to Grifols and they gave me a contact number which didn't work out. The very nice people at the other end of the line did not understand my question. (My fault?). Using the term "genotype" to describe the test sent them down the wrong rabbit holes--interesting but not helpful. Today I called our IRL again and they gave me another number. Nobody answered, but it is MLK day.

Those of you who send out samples from weak D OB patients for molecular testing, do you know, approximately, how much the test costs and whether insurance companies willingly pay for it? I am having trouble finding this information. Thank you! Catherine

What are the regulatory standards for checking the temperature alarms and verifying the temperature calibrations on blood warmers? Our BioMed guy has been doing these checks quarterly but just noticed in the operator's manual that the manufacturer's recommendation is to perform the checks annually. He asked me if AABB or the Joint Commission had standards for the quarterly checks. I looked through the AABB standards and TJC QSAs and can't find anything about quarterly checks. I will stay with the quarterly checks because that is good practice, but wondered if I missed the regulatory standards somewhere. Thank you! Catherine

What are the regulatory standards for checking the temperature alarms and verifying the temperature calibrations on blood warmers? Our BioMed guy has been doing these checks quarterly but just noticed in the operator's manual that the manufacturer's recommendation is to perform the checks annually. He asked me if AABB or the Joint Commission had standards for the quarterly checks. I looked through the AABB standards and TJC QSAs and can't find anything about quarterly checks. I will stay with the quarterly checks because that is good practice, but wondered if I missed the regulatory standards somewhere. Thank you! Catherine

Our rapid HIV kit is non-waived for plasma/serum and waived for whole blood. We just went through a Joint Commission inspection and the inspector, when giving us the heads-up about IQCP, suggested we only perform the rapid HIV testing on whole blood. It seems like a simple solution. Does anyone see a problem with it?

Thanks Liz for the explanation of the 3 month period. It makes sense and it will help me explain to physicians why we need to be concerned about more antibodies forming.

R1R2, No, our antibody screen on 4/18 showed the Jka reaction was definitely stronger. Also, I did not mention this before, in order not to distract from my main question, there was an antibody present to the 0.8% screening cell preservative. When we performed the gel antibody screen with our usual 0.8% cells, all cells were positive at 2+. The auto and DAT were negative, and when I XM'd all of our (8) units of O negative units, those XM's were compatible at gel IgG. So I suspected an antibody to the preservative in the 0.8% cells. As a backup, we have 3% antibody screening cells for tube, and I made 0.8% cells from these cells. The antibody screen with the 3% cells made into 0.8% cells was negative. On 4/18 I ran a antibody screen with the 0.8% cells and the 3% cells made into 0.8% cells. The 0.8% cells showed the Jka antibody and the antibody to the preservative. The 3% cells made into the 0.8% and tested with gel IgG showed just the Jka.

I apologize for posting because this subject has been covered many times. Before posting I read some of the related threads, and I think I am on the right track, but I just want to make sure. I have a specific situation, and 2 specific questions: The situation: Patient, GI bleeder, is O, Rh negative. Patient received 2 units O, Rh negative pRBCs on 4/2/15 at another facility. On 4/10/15 the patient shows up at our small hospital, where we only perform tube ABO/Rh and manual gel antibody screens. Antibody screen is weakly positive. We send the specimen to our reference lab where a weak anti-Jka is identified. However, the patient stabilizes at 9.0 hgb and does not receive any blood products. Patient is discharged 4/12/15. On 4/18/15 I receive a call from the patient’s physician. The patient has been bleeding. His hemoglobin is 6.5. The physician would like to order 2 units O, Rh negative units that are negative for Jka and transfuse the patient. I tell the physician that because the patient was transfused so recently (4/2/15) and because the antibody workup was done on blood drawn 4/10/15, that, on 4/18/15, I would need to draw another sample and send the specimen to the reference lab for a repeat antibody workup. The patient may have developed another antibody. This is the policy at our facility. We ended up sending the patient to a larger facility capable of a higher level of medical care. My first question: Was I correct about needing to test for additional antibodies? A knowledgeable friend suggested it would have been okay to transfuse Jka negative units that were compatible at IgG....but but but... how could I be sure that another weak antibody wasn't lurking? I think Malcolm has covered this subject in a related thread--the donor cells may be single-dose, etc etc. I am looking at AABB Standards 5.14.3.2 and 5.14.3.3--A specimen from a patient that has been transfused in the last 3 months is only good for 3 days and patients with previously identified antibodies must be tested with a method to identify additional clinically significant antibodies. A 3-cell antibody screen is not really a good method to identify additional antibodies My second question: In AABB Standard 5.14.3.2, how did the creators of this standard decide on three months? I appreciate any comments and advice. And thanks for your patience at revisiting this subject again!!!! Catherine

Thanks Whitney for posting this question! I do not have an answer, but your question is an opportunity for me to learn. I was wondering how low prevalence antigens from the MN CHO collection would cause steric hindrance. After reviewing information in The Antigen Fact Book, I am reminded that the MNS antigens are on GPA and GPB which are single-pass membrane sialoglycoproteins. One of the major functions of sialoglycoproteins is to contribute to the negative charge of the RBC glycocalyx. The antigens in the MN CHO blood Group Collection, which are more frequently found in Blacks, are also on GPA and GPA and have altered sialic acid. So, if cell #6 of this Ortho panel has one of these low incidence antigens, there is a stronger negative charge and this stronger charge is weakening the anti-M/M antigen reaction? Is that correct? Wow--that would never have occurred to me. I hope you get an answer! A call to Ortho seems to be in order! And, I hope I do not change the course of this thread too much when I ask if others have seen cases where steric hindrance has caused negative reactions when a positive reaction would be reasonable. Catherine Baldwin CLS, MT(ASCP)SBBcm