[Oh So Misunderstood]

Can't argue with that! So far Quality has not stepped in. They look every once in a while, but don't cross the threshold! As long as we keep our Crossmatch to Transfusion ratio below 1.5, no one looks real hard. If a product is wasted - such as unused FFP or Platelets, they are all over that!

Many time our ER patients are discharged before the Type and Screen is finished. ?? Waste!

[Oh So Misunderstood]

Interesting you bring that up. We have a OB physician that ordered 2 units on every procedure he performed in OR. After pulling him aside and having an "educational" meeting he now uses the Type and Screen approach. He also had no idea of how fast we could get units to him once we had the T/S finished. He still orders T/S's on all his OR patients, but it sure saves us time not having to crossmatch every patient!

Thanks,

John

[Oh So Misunderstood]

Whoa! Ease Up!

Don't misunderstand - this patient was not in a life threatening situation. This was more of a leap before you look situation. The patient never received any blood. This incident was many years ago and by today's standards a Type/Screen would have been sufficient.

Delayed transfusion vs exanguination was never an issue in this case - I'm not that hard hearted.

[Oh So Misunderstood]

That's better than the time a surgeon asked to have 2 O Neg units sent to OR on a patient with an antibody yet to be identified. He assured me that he would not use them until I called to with the "all clear". He needed them just in case things went bad!

Anyone want to by some swamp land?

John

[Trm.31450]

Hi Malcolm,

We do our correlations between the Tango and tube method every 6 months. We also use "inhouse" QC for the Tango and that is another weekly correlation as we type samples used for QC on the Tango and with the tube method.

Another question:

We do the automated CAP survey JAT on the Tango. Can we use the JAT survey as an adequate method for proficieny testing with the tube method? I don't really want to purchase two seperate surveys, but if I need to I will. Also, what about antigen typing as it is not offered on the Tango JAT survey.

Thanks - as always I look forward to your expertise!

Regards,

John

[Transfusion Reaction?]

Update:

Patient came in last night and delivered a healthy baby. So far no blood use, but all is going nicely. No blood necessary at this point. Crossmatch compatible, ABS - negative, and DAT negative. No evidence of any issues at this point.

Good News!

Thanks for everyone's help.

John

[Lookback?]

Hi Deny,

I can agree - we also have never had a patient's physician refuse to make contact with a patient.

John

[Lookback?]

Once our pathologist reviews the lookback he/she notified the patient's physician for the actual patient contact.

[Transfusion Reaction?]

Thanks Eoin,

That part of this story has not been investigated. The patient is current ih-house and her pregnancy continues with no additional problems. She is about 31-32 weeks now.

I will check on the items you mentioned. We just may find an answer!

Thanks for your input - alway nice to hear from an Irish! With the surname of Orr it is pretty obvious where my family came from.

Thanks again,

John

[Transfusion Reaction?]

That was the other oddity. Her chemistries were not outstanding. They matched previous results with only very minor increases in liver enzymes. Her liver enzymes were just barely above the reference ranges. The increases were not enough to trigger out delta checks. The only test we could find that increased significantly was her D-Dimer - somewhere around 4000. Our pathologist said that could be associated with the placenta previa.

Thank for the input - it is appreciated!

John

[Transfusion Reaction?]

The original sample was not hemolzed and had a "normal" appearance. The unit was started and the "post" sample was collected within 4 hours of the start of the transfusion. It was icteric. We have pretty much ruled out a hemolytic reaction, and the patient received an additional unit with no problems. The serum returned to "normal" appearance within 2 days. Cultures were negative. She is also a placenta previa which may account for some of the issues we are seeing. So far the patient is doing fine and her pregnancy continues with no problems to date. ??

thank!

John

[QC for ABID panels and the Joint Commission]

Hi Deny,

Glad we got your Monday off to a good start!

I had a professor in college tell my class that anyone that worked in a medical lab was a little "left of center". At the time I thought that was an awful thing to tell us. Over time I have grown to accept his comment and even admit that he was correct!

Regards,

John

[QC for ABID panels and the Joint Commission]

Malcolm,

You are still a "puppy" - I am 62 with an artificial hip!

Have certainly gone from an A Pos to an A Neg though!

John

[Why do we have to administer blood with in 30 minutes?]

Me too!

John

[Why do we have to administer blood with in 30 minutes?]

Jeanne,

I love it!

Found another that probably started out doing major and minor crossmatches!

Thanks,

John

[QC for ABID panels and the Joint Commission]

Hi Malcolm,

You ever think about moving to the States? We could use you!

Regards,

John

[Why do we have to administer blood with in 30 minutes?]

Good one Malcolm! I once heard that nothing is free.

You made my day with that one!

Regards,

John

[QC for ABID panels and the Joint Commission]

Aunti-D -

Just relaying what CAP told me. I don't disagree that panels need QC, just stating what CAP relayed during an interpretation the CAP checklist question.

John

[QC for ABID panels and the Joint Commission]

We had this come up in a CAP inspection also. I called CAP and was told that the antibody ID was considered an extension of the antibody screen and no QC needed performed. That was a few years ago, and things may be different, but is two subsequent inspections that answer was considered valid.

??

John

[Transfusion Reaction?]

Thanks! I will look that up. We have not yet found a cause that is concrete. Thanks for the information. I appreciate it.

John

[Transfusion Reaction?]

Thanks, we are considering "outside" sources as our pathologist has pretty much ruled out a cause from the blood itself. The cultures are negative, and the only thing is making any sense is like you say - an outside source. We are still investigating, and the patient has improved No more transfusions have been given.

Thanks! It always helps to have input from someone that has been in the "trenches". Appreciate the information.

regards,

John

[Transfusion Reaction?]

I have a culture started on the unit. After some checking I found that she is 28 weeks pregnant, and having issues, but I don't know exactly what issues. I did a D-Dimer and it is 4060 ng/mL - our upper range is 400 ng/mL. Protime and Ptt are within normal limits and the platelet count is 248,000.

Malcolm, ethnic origin is Caucasian. No previous blood bank history at any facility. Her last Hgb is 8.6 so she has stopped the hemolysis process, or at least it appears so. The physician wants to transfuse the third unit, but I have said "NO", feeling it too risky right now.

Thanks for all the input - I am a little confused by this one!

Thanks,

John

[Transfusion Reaction?]

We have a patient that came in to L/D and delivered a normal infant with no issues. Patient's Hgb dropped and 3 units of PRBC were ordered. The patient is A Pos with negative ABS. No previous history, and crossmatch compatible.

During the first portion of the second unit she had some sort of reaction. Her serum is now icteric and her Hgb has dropped from 9.3 to 8.0. Hgb. was 7.7 pretransfusion.

Direct coombs testing is negative both IgG and Poly. All rechecks are fine and all compatibility testing is compatible with both pre and post samples.

Something definately happened, but I could use some ideas!

thanks,

John

[Lookback?]

At our last DNV inspection we were given a web site to obtain a form to fill out for lookbacks. We have been able to get the forms from the web page until a few weeks ago. We were told we could not store forms and had to obtain a "fresh" copy each time a form is needed.

Does anyone have some he?!

Thanks,

John

[Advice about Emergency Release]

Deny,

Thanks - that is exactly what I am looking for. We are only using a single sheet and have a difficult time getting back vitals for documenting in our LIS. A form like you mention would be great.

thanks!

John