jcdayaz

Washing is out here. There is no capability to wash anything..even at our local reference lab! Anything needing to be washed goes to their main reference lab in California. We have not had any IgA deficient patients needing transfusing since I've been here. That's the only time that I'm aware of washing is still indicated. Someone feel free to correct me if I'm wrong!

You are off base here with this response. The reasoning is not "Techs don't have to think"...the reasoning is that's what our blood supplier will provide us with on a weekly basis! We only get O Pos and O Neg regular(no pedi-packs attached)irradiated, cmv- units. EVER! We get one Pedi unit each week. When a fresher one comes in if we haven't used any of the previous one for an infant we put it in our general irradiated inventory.

When I worked in the Blood Bank of a Pediatric Hospital we were able to sterile dock our own aliquots as needed. We would give type specific, cmv-, irradiated blood each and every time. We don't have a sterile docking unit at my current facility. You have to work with what you have. Our blood supplier is ONLY sending us O Neg baby units. We have typically two baby units on our shelf at a time. If we have not had a baby that needed to be transfused from a particular unit within 7 days, we disconnect the pedi-packs and put it in our general irradiated inventory. We do not have a large neonatal blood need. It is only occasional.

Yes, all our "baby units" are O neg, CMV-, irradiated, CPDA-1, with sterile pedi-packs attached. It would be impossible for us to keep inventory of a baby unit in every blood type. O neg is universal, as you well know, it is safe for any baby to get. It works for us! Also all of our normal irradiated stock is only O Pos and O Neg. We have an outpatient chemo/cancer transfusion service and several times a week irradiated units are requested. We use our irradiated O Pos or O negs in this case--regardless of the patient's blood type.

No washing in our Blood Bank either. We get every week fresh "baby units" from our donor facility--it is a standing order. "Baby units" for us are CMV-, irradiated, leukodepleted O Negs with sterile docked pedi-packs attached. When we receive a fresher one, we move the current "Baby unit" to our general irradiated inventory if we haven't transfused a neonate with it. We try to use the same unit if we have transfused a neonate to reduce exposure to whatever.

Sorry, no such thing as "Too much fun" on a Sunday at work. When/if all work is done, reviewing/filing/etc etc. we play on Sundays too! There has to be some reward for working a Sunday! (Workload permitting, of course).

I'm with you L106. No Dr. Clapp name for me....maiden name would have stayed!!!!

Well Malcolm, You tell all of us what Blood Group System "de novo" is in!!?? :D:D:D:D

You make some valid points here. They do NOT get enough training in BB. They are ill-prepared to make decisions that some have to make on a daily basis. The scariest situation I can remember is that Path residents get a whole 3 weeks training?!(or that's what they got in the BB where I was several years ago). How can anyone, yes even a DR, learn BB'ng in 3weeks? I think the good DR's are the ones who know what they don't know and ask for advice from those of us who do. Unfortunately, it's not terribly common! The DR in the situation I described here was having a fit because it was going to take 20 mins to get him his FFP. He was not pleased.

I had a vascular surgeon once ask me why the FFP was frozen?! I responded "Because it is Fresh Frozen Plama(emphasizing the word FROZEN)." He wasn't terribly amused. That's one of the DR vs. Tech challenges I actually won! That is a rare happening in my experience. The BB/lab always seems to get blamed for everything!!

YES! There are many "unexpected" things that occur in Blood Bank. Electronic crossmatching works...go for it! If your original antibody screen is negative, your manual crossmatch (9 times out of 10) would be compatible also. So it is just wasted time, resources, etc. to crossmatch these particular patients. I won't lie.....Electronic Crossmatching was VERY scary to me at first. Now I LOVE IT!!

Yes, let's talk about our "mobile society". How are we, as Blood Bankers, to know of previous history from another hospital? Many times patients don't even tell anyone they have been transfused at "X" hospital. It is worrisome, to say the least. There are always inherent risks with transfusion. That goes without saying.

Tucson, AZ. (USA) I hope you are not going to use this situation to present electronic crossmatching in a negative way. It works! A "real" (manual) crossmatch wouldn't have detected antibody and/or incompatibility in this instance anyway.

The original units were electronically x-matched. Even if they were manually crossmatched the units would have been compatible. The antibodies weren't reacting. We routinely electronically x-match patients that have no antibodies. The units never left the Blood Bank. When the Tech called the nurse to tell her blood was ready she told him about the antibody card. Thank goodness!!!!

We use the Gel method on the Provue routinely. We resort to other methods when/if necessary--if we know there is a problem. The Tech had no clue based on his routine testing results! SCARY! Yes, I agree with you on your antibody card statement with proper education of the patient.

Yep...NEVER happened again. I will say my description of a "huge error" is probably different than other Techs. I expect perfection..each and every time from myself. I set up O neg units on an O pos patient when we were EXTREMELY short on O negs. UGGH!

Here is a scary situation for you all....A Tech I work with had a case last week where the Antibody Screen on a patient was perfectly negative. We do electronic crossmatching (although that wouldn't have mattered in this case). He then set up the 2 requested units for the patient and called the nursing unit to let them know the blood was ready. The nurse he spoke to replied "she has this antibody card, do you need to know about it?". She then faxed a copy of the card to the BB and it turns out the patient had an identified anti-E,c from years ago from an out-of-state hospital. Both units that had been set up were, of course, c positive. The units were not transfused...thank goodness. The Tech fixed everything and got appropriate units ready. How scary is that??? That patient was very proactive in her own care and I applaud her for that! We need much more of that! I was, however, a bit surprised to see 2 Rh antibodies just disappear. Even without stimulation I have always thought the Rh's stay around. Am I wrong?

[ One night they ordered a STAT FFP. Just as the order was printing, the Nurse called and asked if she could come for it. He said, "No, it takes 25 mins. to thaw." To which she replied, "you do know I ordered it frozen don't you?" He said he wished he had had the presence of mind to reply "what are you going to do, give it as a suppository; a poopsicle?" Brenda Hutson

You betcha! Sometimes you have to do what you have to do! Apparently this particular nursing floor was drawing their morning run, lining all specimens up on the counter at the nurses' station, and THEN labeling them. Against hospital policy, nursing policy, phlebotomy policy....etc etc to not label a specimen at the bedside immediately after collection. Complaints, reports to management, etc went unrecognized. Thus the CAP/Joint Commission report. The "situation" got resolved quite promptly.

Very well said, Brenda! I once almost made a HUGE error(in my eyes)...I caught it before it left the department, but I was then so upset I went to the restroom and threw up! My supervisor at the time told me to calm down, that it is only a "mistake" if it leaves the blood bank. WRONG!!!!!! I could go on and on....but I won't. We are all only human. It is what it is. But to not recognize the potential of patient harm by making errors in the blood bank--and the lab in general--is not okay.

Really? All these years I've been using incorrect terminology! How sad is that?! So every step in the process is called aDsorption?

OK Malcolm..I'm taking a risk here....I have always been taught that the "process" was called absorption and the end result was called "adsorbed plasma". Have I been repeatedly misguided?

The plasma is split into three aliquots, and each is then adsorbed by the R1R1, R2R2 or rr red cells. These are incubated at 37oC (usually, but, if a "cold" auto-antibody, or a mixed "cold"/warm auto-antibody is suspected, 4oC) for about 20 minutes. The mixture is then centrifuged, and the plasma, if initially in R1R1 red cells, transferred to another aliquot of (packed) R1R1 red cells (if R2R2 then to the next aliquot of R2R2 cells, and, if initially rr red cells, to the next aliquot of rr red cells). The incubation is repeated, as is the centrifugation and the transfer to the next aliquot of red cells. What Malcolm describes here is how we did it at my reference lab. We made our own red cell stroma concoctions using 3 different cell types--the same as Malcolm described. Then after absorbing we would test the adsorbed plasma with our regular antibody panels.

THIS THREAD IS HORRIFYING TO ME! I have never heard of such mistakes being made by the same Blood Bank Tech repeatedly. We all make mistakes, each and every one of us has--INCLUDING ME! But the situation you describe here is absurd. Go as high as you need to go to get this person OUT of the Blood Bank. CAP, FDA, Joint Commission, CONTACT THEM ALL! You might not be very popular with your co-workers if they find out, but you will potentially be saving someone's life. If I were in your shoes (Thank goodness I'm not), I would stop at nothing to get this person out! It sounds like you have exhausted your in-hospital resources, time to go further and higher up the authority chain. This Tech is going to kill someone. And, yes, the wrong blood type issued to the wrong patient is an FDA reportable event. Whether or not it was actually transfused...just issuing it was a reportable event. I believe (someone please correct me if I'm wrong) the situation you described about the E,c patient is also a reportable event. I do not envy the situation you are in.

I worked many years ago in a hospital that serviced many dialysis patients. They seem to not infrequently have this "Crap" phenomenon. After unsuccessfully identifying why multitudes of times, we started using the term "Anti-Dialysis" to describe what we were finding.