Sue Miller

Thank you Liz. That is exactly what I needed.

We have had a rash of incidents where the nurse are puncturing the RBC unit with the infusion set as they spike the bag. Does anyone have any visual aid information that we could send out as an education tool to the nurses for the proper procedure to enter the bag?

We also have the same issues. We keep the cells in the refrigerator when not in use. I also split my monthly shipment receiving 2 vials in one shipment and then 1 vial in a second shipment 2 weeks later, trying to have fresher reagent in use. Quotient is working on a C3 check cell prep kit that will allow you to make your own in house, which should be much stronger since the 28 day expiration will start there instead of at the manufacturing facility. Looking foward to whenever that is ready for release.

I suspect that noone has been cited by CAP because CAP is a peer inspection and most of us do not think an IS crossmatch is required when you are performing an AHG crossmatch and entering results in a LIS.

We had similar results as GIT on last PT. We have switched to Ortho in spite of former problems with handling of recalls because of the false positive results we were getting with Immucor and their seemingly lack of concern. We have only been using Ortho since Jan. so we are monitoring the false positive rate.

For us TypeSafe is .16 each and hematype is .20. One of our techs works at another facility who had an issue with a broken tube and exposure with TypeSafe so we are reluctant to switch even if it is cheaper.

John Judd did a large study (222,000 antibodies) in 1997and concluded that if you use 2 screening cells that are R1R1 and R2R2 and one of these is homozygous for Jka is adequet for antibody detection. Ortho and Immucor both have this product. The paper was titled "Commmentary: testing for unexpected red cell antibodies-two or three reagent red cell samples?"

Please send me a copy also.

My checklist is based on our Blood Administration policy. I just have listed what we state in the policy and make sure they adhere to it.

We have been using the Plexxium with hard wiring for about 3 years and have been very pleased with them. We have 2 nodes and about 35 systems connected to them. We also have chart recorders as a back up on our blood bank equipment. When inspectors want to see temp charts it is so much easier to show the graphs from the Plexxium that diggng through charts.

We store our anti-C3d,C3b and complement control cells in the refrigerator and only have them on the bench when in use. I have also split my standing order to get shipments every 2 weeks.

I bought one of the Westcott smaller racks thinking that the techs would like them because they do not take up as much counter space. They never use this rack. After 3 years of using the larger racks they do not want to change.

The recent lot number seems to be better. Our saline always has a pH of 7.2 and we still experienced many false positives beginning about September.

We also have seen many false positives with negative KB stain. Immucor originally advised washing the specimen numerous times before beginning testing when this problem appeared. Sometimes that seemed to work but not always. Then they advised not washing the specimen. The current lot number seems to be doing better. We have been documenting our fetal bleed and KB results and how the specimen was treated, i.e. wash vs not washed. I sent this information to Immucor but they really did not seem very interested. They wanted to say the problem was with our saline which we have used forever. They had me do a pH on each cube we were using and all were in range.I am anxiously awaiting the to see how everyone performed on the CAP PT from November.

We currently perform a DAT on any patient who has a type and screen or type and crossmatch and has been transfused within the last 3 months to identify delayed transfusion reactions. I would like to discontinue this practice. What does everyone think of this practice?

We use Teruma SCD and heat sealer and are very happy. The heat sealer has a small shield over the sealing area to catch any little squirts.

We have ProVue interfaced to Cerner ME and after some rough times getting it set up it is working great. We have type, screens and cord bloods interfaced. Techs love it. You will want to have a back up gel station for any down times. We found cord DATs in gel are stronger than tube DATs so thewre is not good correlation. Also you would probably want to perform gel panel to complement the ProVue. We only have one ProVue so we perform our panels in manual gel.

We validate every shipment/lot.

We have been using Gamma clone Rh control. After looking at the price increases I was wondering what other people use for a control. We use it for AB pos typings and patient with a positive weak D.

Our nurses are proposing taking vital signs pretransfusion, 15 minute and post transfusion. At the one hour mark the nurse will "assess" the patient which includes asking how they are doing and taking vitals if the nurse thinks it is necessary. We are concerned that the patient assessment will not happen or may miss a reaction that taking vital signs would pick up. Does any one have experience with the assessment approach?

When using gel method anti-M sometimes shows as a mixed field which indicates to us it is probably and IgM cold reacting antibody. It does not seem clear cut to me though if it is not showing mixed field does that mean it is an AHG reacting antibody? According to CAP J-B educational challenge it states that only antigen negative units should be given to a patient who has an AHG or 37 degree reacting anti-M. What does everyone do with anti-M who uses gel? Do you give crossmatch compatible or antigen negative?

We have used the Plexxium system for a year now. Initially there were a few bugs but they have been worked out. Most of these problems had to do with learning what to set the limits at for the eqipment. For instance some freezers have a defroast cycle so they get a little warmer at specific intervals. A small incubator has larger temperature fluctuations normally that a large incubator. Also placement of the probe in the equipment is important. We had difficulty identifying a good medium to use for the probe for the -70 degree freezer. We ended up placing a test tube in cooking oil and placing the probe in there. We are very satisfied with the system and the support. We have attached about 32 pieces of equipment to the system for the whole laboratory and have one remote location. We monitor incubators, RT, freezers, one -70 degree freezer, platelet incubator and refrigerators. Having a monitoring system sometimes is annoying for the techs when the alarms go off but it is amazing what is going on in the equipment over 24 hours. It really is a good way to head off problems.

Does anyone have a weight limit or age limit when you switch from group specific or compatible to any type platelet for transfusions?

It would be interesting to take a poll on this topic.

How is everyone interpreting the new JCAHO guidelines on bone and tissue? Do these guidelines say that the laboratory should oversee the bone and tissue program in a hospital?