sgrassley

All, I am about to blow your mind....
Our plasma freezer is down and so is our backup. The freezer will not get colder than -18 C. I was preparing to move all the products into boxes with dry ice until I had a conversation with my 87 year old dad, a retired blood banker from University of Chicago. He said to me, do not take the plasma out of the freezer and put it in boxes, PUT THE DRY ICE IN THE FREEZER, IT IS THE BEST STORAGE BOX YOU HAVE!!!!
MIND=BLOWN!!!!
I did that. Our freezer is currently reading -25.1C and getting colder. Furthermore, the probes in the freezer continually monitor the temp in the freezer so you don't have to record temps every 4 hours, the chart is doing that for you!!!
Isn't that cool? That perfectly illustrates the difference between wisdom and knowledge there. I wish we could hire my dad.
I just had to share this here.
PS. Freezer is now at -26.4C.
 

I would pull the unit from inventory and contact the supplier. They should have the resources to investigate the problem with the donor.

I would pull the unit from inventory and contact the supplier. They should have the resources to investigate the problem with the donor.

I would pull the unit from inventory and contact the supplier. They should have the resources to investigate the problem with the donor.

I would pull the unit from inventory and contact the supplier. They should have the resources to investigate the problem with the donor.

I would pull the unit from inventory and contact the supplier. They should have the resources to investigate the problem with the donor.

I would pull the unit from inventory and contact the supplier. They should have the resources to investigate the problem with the donor.

I would pull the unit from inventory and contact the supplier. They should have the resources to investigate the problem with the donor.

I would pull the unit from inventory and contact the supplier. They should have the resources to investigate the problem with the donor.

I would pull the unit from inventory and contact the supplier. They should have the resources to investigate the problem with the donor.

We use the 6ml Pink EDTA tubes. We require the specimen be up to the bottom of the manufacturer's label. (~2 ml) That way we won't run out of plasma if the patient needs a lot of units crossmatched. (No electronic crossmatch yet!) If the patient happens to have an antibody we may need to have the patient redrawn, but it usually work out.
Back in the day, the tubes contained liquid EDTA and we required 1 ml to avoid over-dilution of the specimen for Hematology testing.

We use the 6ml Pink EDTA tubes. We require the specimen be up to the bottom of the manufacturer's label. (~2 ml) That way we won't run out of plasma if the patient needs a lot of units crossmatched. (No electronic crossmatch yet!) If the patient happens to have an antibody we may need to have the patient redrawn, but it usually work out.
Back in the day, the tubes contained liquid EDTA and we required 1 ml to avoid over-dilution of the specimen for Hematology testing.

If the total inventory is only 6 units at a rural hospital, I would stock 4 O Pos and 2 O Neg. I'm not suggesting every hospital should stock only 'O'!

I would probably switch my inventory to stock only 'O'.  

If the total inventory is only 6 units at a rural hospital, I would stock 4 O Pos and 2 O Neg. I'm not suggesting every hospital should stock only 'O'!

If the total inventory is only 6 units at a rural hospital, I would stock 4 O Pos and 2 O Neg. I'm not suggesting every hospital should stock only 'O'!

We've seen this problem in the past. It can easily happen if the tech uses the 'patient' bottle instead of the 'crossmatch' bottle. There is no barcoding to help 'catch' this as there would be if it was an actual crossmatch of the unit of blood in the computer.

The ER doc has a patient bleeding profusely so he clicks a button in the computer and voila, blood will magically appear at the patient bedside. This might be fine for non-emergent cases but what about the patient that needs blood right now?
How is the blood bank notified of this order? Does it pop up on a screen somewhere? audio alert? print on paper? Wherever/however the notification occurs is there someone present 24/7 to take immediate action?
 
We are a 400+ bed hospital with a level 3 trauma ED. When blood orders are entered in the computer a copy of the order prints in the blood bank HOWEVER there is not always someone in the blood bank to see that printout, especially on off-shifts where techs cover multiple departments.
 
For that reason ANY time there is an emergent need for blood/components whether ED or inpatient, the blood bank must be notified by phone because:
1-we have an open concept lab and there is always someone in earshot of the phone and
2-it gives the tech an opportunity to ask for clarification of needs i.e. your ordering 4 uncrossmatched O- pRBCs? Do you want FFP to go with that? 
You'd be surprised how many times the call for uncrossmatched pRBCs ends up being more components when blood bank asks the questions and how many times we have been able to anticipate additional need for product or staff (pt is being moved to OR for leaking AAA) because we asked the right questions. 
 
The ONLY exception to the call rule is when there is a Trauma patient brought in by squad, then the blood bank is alerted by a text pager (audible throughout the lab) with information about the type of trauma and patient conditions as observed by medics i.e. male, mvc, +loc, gcs 10, multi fx bilat legs. In these cases we immediately prepare a trauma cooler with 2 O- pRBCs for pickup by the ED runner. Any additional blood/components require again require a phone call.
 
So in the long run, what may seem like an easy fix to the ED director may not be the best fix for patient care. If the ED director/staff has no idea of your lab layout and your processes then it might be a good time to invite them down for a visit and for everyone to go over how the process works from the time the patient arrives to the time the blood they requested gets to the patient. This is what we did when we started Trauma services and it can be eye opening for everyone.

I am going to be REALLY unpopular here, but I'm going to say it anyway (because I am a pedant)!!!!!!!!!!!
 
Antigens CANNOT be either heterozygous or homozygous; only genes can be heterozygous or homozygous.
 
An antigen can be described as either showing homozygous expression, or heterozygous expression.
 
That having been said, is a red cell sample that types as K+k- phenotypically, genotypically K/K or K/Ko, or even K/k, with a mutation within the Kell gene that prevents the k antigen being expressed and detected with all anti-k grouping reagents (just in case anyone doesn't believe me - we had one!).
 
That's got that off my chest.
 
Now then, there is NO doubt that there are some anti-K's around that only react with K+k- red cells (dosage), but they are fairly rare, however, how many people use antibody screening red cells that are K+k-?  I doubt if there are any.  Therefore, we are all ruling out anti-K using red cells with apparent K antigen heterozygous expression on every single sample that (apparently) has no atypical alloantibodies present.  Am I wrong about this?
 
It follows, therefore, that, over the years, there MUST have been occasions when a patient with a very weak anti-K (one that is only detected using red cells that are apparently showing homozygous expression) and who has been transfused with K+ blood (do the maths).  As far as I know, there are no papers within the literature that report a case of either a delayed or an acute transfusion reaction as a result of this.  Yes, this may cause the anti-K to become stronger (and, hence, be detectable using an apparent heterozygous red cell sample showing K+k+ expression), but then, if this happens, you give K- blood.
 
So, my considered answer is that you can exclude using K+k+ red cells.
 
I shall now go and lie down!!!!!!!!!!!!!

Is anyone else missing the snow and smashable Christmas lights from last year as much as I am? 

We are the runners for MTPs. We don't have "extra" staff either, but it has shown to work for us. The Blood Banker stays put, another tech or phleb or supervisor becomes the runner.
1. We know where the patient is and can get the blood directly there to the bedside (or to the OR nurse who meets us at the OR door). The unit won't get left on a counter, handed to the wrong nurse, etc.
2. We know when the blood is ready to go out the door. You're trying to work on a MTP and multiple people are coming in yelling, tapping their foot, etc. We don't like the drama in the BB where the tech is trying to concentrate.
3. We can interact with nurses and docs about how the patient's doing...should we run faster, or slower? This also keeps unnecessary phone calls to the BB tech.
4. We're covering our......we can't get blamed later for a delay if we get the blood there as quick as possible. The trauma docs love it, and it shows good customer service on our part.

And you could get in trouble using a homegrown system that is not FDA approved. Soft has an FDA approved transfusion module for nursing called SoftID Tx. It has many safety features and a lot of flexibility. You should look into it.

We are just starting the process of upgrading Cerner Classic to Milennium. Seeing as Classic will sinset in 2015 your facility will have to do something soon. The upgrade willl improve the blood administration part immensely. Nurses currently have to type in the whole ISBT number. Not good. Our facility has hired a Blood Bank consultant (not Cerner) to work with us and Cerner to make sure we get what the BB needs in this project; barcode scanning of specimens, products,and anything else. I think this will really help us, otherwise we tend to be ignored.