jcdayaz

The coolers need/have to be tested, verified and DOCUMENTED that blood is maintained at appropriate temperatures for the amount of time that your blood bank allows the coolers to be issued. Each unit issued in a cooler must have a temperature indicator on it. When you say "ice packs" I hope the units are not being placed directly on the ice. We have an inner plastic type square bucket in our coolers and place one frozen pack and two ice packs on either side of the bucket. The coolers have been calibrated to be acceptable for 6 hours. We start calling and telling the ER, OR and ICU after 4 hours to return the coolers. It gives us a little time to be sure we get the cooler back in time. We will not send coolers to regular floors except in extreme circumstances like a plasma exchange or something like that.

WOW! And the PEG adsorption discussion goes on ..... When are these antibodies going to start reading the rule books? haha! I had a patient just last week with a fairly impressively strong warm auto (3-4+)--I did 3 successive PEG adsorptions and couldn't get rid of it. The testing had started on the previous 2nd shift, continued on the third shift and then was "gifted" to me the next morning. After I spent close to 7 hours on it, I finally gave up and sent it to our reference lab. They start with PEG adsorptions also. They had to convert to the WARM adsorption procedure. Does anyone have any information on when/why the PEG adsorption doesn't work? Thanks in advance.

AMEN! I think to be a Bood Banker you have to be nuts!

Brenda, I concur completely with you. We use HemoTemp indicators on every unit sent out to OR (typically) in a cooler. The temperature of the units upon return--if they are returned--is documented in our computer. Our coolers are validated for 6 hours safe storage time based on our in-house validations. We will call the OR @ the 4-5 hour time frame post-issue and ask for the return of the cooler to the BB to get fresh cooling packs, frozen packs, etc. We have a dry-erase board upon which we write when whatever cooler was issued so we can all monitor the length of time it has been out. BTW-I've not heard anything either about a change to the 30-minute rule. If you find anyting out please let me know.

Good luck finding an E,e negative unit to transfuse in situation #1 you describe here. If it were me and the patient absolutely HAD to be transfused right now, which it sounds like she/he doesn't, I would go with E negative blood. It sounds like the e is a possibility, but not present yet. Yes, it's rolling the dice, so to speak, but what options do you have? In this situation we would call the attending physician and "Strongly Urge" the use of steroids to try to get the Auto antibody under control. Obviously we can't prescribe medicines, but we can "Suggest" their use when appropriate. The Doc's are normally very receptive to our "Suggestions". We have a patient that comes in from time to time that has the exact same scenerio. Sometimes when her Auto is strong enough, we just simply tell the Doctor there is no compatible blood and he/she will have to sign an Emergency release form for incompatible blood. Then it has to be OK'd by our Medical Director who has to sign the emergency release form also. He will call the attending physician personally prior to signing the form to ascertain true medical need. It's a pain, but sometimes what choice do you have? We have done this probably only twice in my years at my current facility. Odd how the urgent need for blood becomes a little less urgent when a MD has to put his/her signiture on a legal document.

The PEG I referred to in my previous post is not a regular PEG panel using neat serum. It is a PEG adsorption procedure. You can get the same (if not better) adsorbed plasma/serum to then use for your regular antibody id. I don't see a way around the adsorption step, but I do know the PEG adsorption can save hours!

Sorry to be the bearer of bad news, but in my experience you will maintain your headache if you pursue the WARM procedure. The PEG procedure is much easier, quicker, etc etc. In my humble opinion, the step in which you use the PEG procedure is after a panel has been performed to check for "real" specificity and a positive auto-antibody has been confirmed. Then you can use the PEG process to show any underlying alloantibodies.

We have an option in our computer system to enter "Least Incompatible" in our crossmatch result section. We then contact the physician and require a new order to be written and sent to us by him/her for "Least Incompatible Blood" to be transfused. This has to be ok'd by our Blood Bank Medical Director prior to issuing any blood for the patient. That's how we do it. Good luck!

When you're done cutting Harry's "offending bit" off, I have a couple of my own clever ones for you to take care of....

Well, hmm. I think the term "strictly" just might not apply here. Are you saying if you have something like an Anti-k your policy dictates that you have to find 3 homozygous cells to prove it? We keep 6 months of expired panels to use for select cell purposes. I'm not sure we would be able to find 3 homozygous k cells in our six month inventory.

Kudos to you KKidd! I agree, except for the "2 grade increase" and the "been a long time since the patient has been at our facility" statements. I think "been a long time" is not objective enough. What one Technologist thinks is a long time might be vastly different than another Technologist thinks. I have seen a couple of cases of Fya and Jka that presented themselves with only a slight increase in screen reaction strength. Certainly not a 2 grade increase. (Totally not applicable to your post, but...)In the world of blood banking I have always been taught if I see hoof-prints I am to look for horses first. If a horse doesn't match the print then I look for zebras. It has served me well in my career. I hope it can help someone else!

YOU HIT THE NAIL ON THE HEAD WITH THIS STATEMENT!! It seems, unfortunately like a large percentage of physicians graduated from Deny's "God 101 class"(see her previous post). Unfortunately often times they don't know and/or recognize that they don't KNOW the appropriate treatment for their patient--even after we tell them(well, strongly suggest) the treatment that needs to be used. Funny thing....When my Blood Banker friends come to my house we always eventually end up discussing blood bank issues. Even my own husband doesn't get it!!!! Not surprising I know, but he will debate and argue and etc until we just shake our heads and know that there is no hope. Oh my, the patience it takes to be a blood banker and married to a physician is UNBELIEVABLE CALGON, TAKE ME AWAY!!!!!

I LOVE the "God 101 class" statement you made!!! Kudos to you Deny!!!!! The very unfortunate fact is that it is all too common.

Hey Malcolm, I got the right "fallible" this time!:cool:;)

As Lara123 stated very well, even with that IS crossmatch there is the potential for mistakes made by your Technologists. We are all human and are fallible.

In my humble opinion, there will always be certain cases that don't follow the rules(so to speak). We do electronic crossmatches on any patient needing blood that does not have any antibody "issues". It works GREAT for us!

HAHA! Yes, very embarrassing:redface: Sounds like the time early on in my career that I sent what turned out to be an Anti-M to a reference lab.:redface:

Very well said Colin! And VERY true!!! I think what you posted is a sign of a good Blood Banker. Most of us seem to be stubborn and strong-willed, but hopefully still receptive enough to learn from new information/experiences. Or,in my case, be reminded of what you used to know before your two young children drained the memory from your memory bank!:cries: This site would indeed miss Malcolm. His posts are always so informative and educational!

Funny John.:D Nice one. I hope I don't fit into the category Malcolm is referring to!!

Very true Malcolm! In my humble opinion a good nurse/doctor is one who will admit he/she is not very "schooled" in Transfusion Medicine issues, ask for help from us, and then actually take it!

Great one phil!!!!!

I'm guilty also!

How about answering the Blood Bank phone after being paged by the central lab to take a call "Hi, this is Jane in the......um(long pause), um(long pause)...How can I help you?":redface: How sad is it that your brain can get so fried by some ridiculous antibody you've worked on the entire day that you can't even remember which department you work in????:cries: