[Specimen Collection from Isolation Patients]

How does your institution handle collection of specimens for a patient in isolation? Our phlebotomists have taped a biohazard bag to the door jam and placed labelled samples in the bag. Unfortunately after removing their gown etc. we have had several cases of forgetting the bag taped to the door. We are seeking perhaps a better method. Any ideas?

[Providing crossmatched blood to be transfused outside of our organization]

Thanks for your input. I do know we will be collecting the samples at our facility however once the crossmatches are performed we do not have control over the transfusion process nor the transfusion reaction follow ups. Transportation is not a very big issue since the facility is across the street from the main hospital, however the actual transfusion is another matter. Needless to say I am not excited about losing any control. As a blood banker I need my control!

[Providing crossmatched blood to be transfused outside of our organization]

Our Blood Bank has been asked about providing crossmatched blood to be transfused at an oncology office outside of our organization? Does anyone have an experience with this and what are the regulations involved?

[Salvage Plasma]

Like every transfusion service we are tasked with cutting costs. Can anyone tell me whether a transfusion service can sell thawed plasma that has expired as salvage plasma? We are looking at a way to minimize our losses. I know I have done this in the past but we were the collecting facility as well as the end user. Also I would appreciate any information concerning labelling or companies you might be familiar with using. Is there a minimum amount of plasma needed to enter into some type of contract with a salvage purchaser?

[Ortho Selectogen cell I false pos on lot VS490?]

Hi to Shauna and anyone else interested. It doesn't look like too many found any reactivity with this cell so it will be interesting if they figure out anything.

Now we keep seeing weird reactions on panel A cell 9.

We have also been experiencing weird reactivity on our screening cells and the same panel cell. We have been recording the donor numbers in a log book to see if the phenomenon is repeated as Ortho utilizes the same donor.

[Galileo vs Tango unspecific positive reactions]

Mary- I would also be very interested in obtaining copies of any side-by-side studies concerning the Tango, Echo, or Provue. We are in the process of evaluating Blood Bank Automation. We currently use manual gel and tube for back up. Sales reps have presented fewer false positives with the Tango but I have not had the opportunity to speak to any end users who have used the Tango for say one year. I think it takes at least a year for you to see some of the unique problems with any system you use. Would appreciate feedback from any Tango users.

[PCH Help!]

I have a patient with a history of Non-Hodgkins Lymphoma. She has been fairly asymptomatic for the past few years. Recently she began showing signs of anemia. DAT testing revealed a negative IgG but positive C3.

The oncologist suspected a cold agglutinin or PCH and tested for Cold Agglutinins for 3 consecutive months through the winter and all were negative, Mycoplasma testing was negative. He then ordered Donath-Landsteiner testing, I/i antigen testing and P antigen testing.

We performed a modified cold panel using cord cells pooled from 3 patients and the only result which was positive was the 4C inbcubation with the cord cells 2+. There was no hemolysis with the Donath-Landsteiner testing and the patient typed P1 negative. Does anyone have any insight on what could be causing this patient to hemolyze?

The oncologist reports her hemolysis has improved as the weather has warmed. Appreciate your help or suggested testing.

[Specimen Contamination Collection below IV]

What is your policy for collecting specimens below an IV?

[Specimen Contamination Collection below IV]

What is your institutions policy on collecting a blood sample below an IV? Do you stop the IV prior to collection?

[Meditech Users-- Help]

In Meditech Client Server 5.64 is there a way to attach the 2nd retype to the testing to ensure units are not released prior to the confirmation with the 2nd sample. We have patients coming in for preoperative testing weeks prior to their surgery. The 2nd sample may not be collected until they come in for their surgery. How then do you ensure your retype is performed prior to issue?

My hope is there is some question to over ride at the very least.

[Resulting antigen typing on the second unit of a double red cell collection from results obtained from first unit]

Molecular testing is a whole different ball game with different procedures to follow. As long as the units are serologically typed, I agree with John and follow the KISS principle (Keep it simple stupid) whenever possible. Whenever I change procedures or even consider changes, I take this principle into account. Many Transfusion Services do not have dedicated Blood Bankers 24-7. Deviations from the Norm can often be missed and result in serious consequences. The most common problems I find is a tech that "thinks" they know the procedure so they don't bother to look it up. By keeping things uniform there are fewer errors.

[gloves on while handling units]

I agree with JP. Enough is enough. These units of blood are the most tested thing in the lab. As long as they are sealed and intact---

[Blood Ordering Policy]

How does your hospital handle physician orders for blood? My specific question --if a patient requires special units such as irradiated, CMV neg, Sickle neg--does the physician have a written order specifiying these requirements or is it the responsibility of the Blood Bank to recognize the need and give appropriate units. We have run into some seroius discussions with the orders matching the products. Most of our docs order PC period. It is often the Blood Bank who calls and questions or recommends. Would like your thoughts and input.

[Charging for multiple antibody panels]

Using logic no other business performs work for which they are not compensated. Therefore when you perform 2 panels to ID an antibody and it cost you to identify the antibody, you should be able to charge for the work performed. If this is not the case then the cost of all antibody identification must be increased to compensate for the additional cost of the multiple panels on the few. If we do not use this principle we will quickly not be able to provide the services. Of course what in our field is ever logical when it comes to compensation?

[Billing for Transfusion RXN Workup]

I know it has been some time since you asked this question about charging for the transfusion reaction workup. I too am in VA and have the same issue. What did you ultimately decide about charging the patient?

[Hospital wanting to make switch from glass tubes to plastic for serologic testing]

I was very interested in the use of plastic tubes. It has been an issue in our hospital for years. We have held out and are the only ones currently using glass tubes. I would be interested in exploring the possiblilities of plastic. We are currently using manual gel but still perform all difficult testing in tubes. Did you have a validation plan to share?

[Economy's effect on your hospital]

After reading many of these posts, I feel somwhat fortunate. We are in a hiring freeze, if someone leaves they are not replaced. We have seen drastic cuts to our benefits. Our retirement has been revamped, our PTO has been merged with our sick time. Many employees with many years of service have lost hundreds of hours which will no longer be paid. Basically we had hospital meetings which explained our current plans were not sustainable. There has been very little back lash from all of this because I think everyone is just happy to be employed. So far there have been no lay offs merely attrition. There is a great deal of concern about the current political situation and reimbursement. Basically we are just holding on. This is definitely the worst time I can remember in my 25 years in the medical field.

[Patient ID using Blood Bank Armbands]

Thanks for you help. Do you keep all this paperwork in a manual form or do you also have it documented in a computer system?

[Patient ID using Blood Bank Armbands]

We use a separate blood bank armbanding system similar to Typenex. My question do you have 2 people ID the patient prior to placing the Blood Bank armband on the patient and if you do how do you document the identities of the two identifiers?

[Need help with pneumatic tube transport of units]

I was reading through your response and wondered if you could email me the validation procedures for the pneumatic tube system as well. I am in much the same condition. We have never tubed blood to any of the units. My email is dcampbell@augustahealth.com. Thanks.

[Pneumatic Tubes for Dispensing Blood]

Do you have a copy of your SOP? Also do you have the larger diameter tubes by PEVCO or the smaller tubes? I have been interested in validating tubing blood to the units however we have the smaller PEVCO tubes and so far I have not seen any hospital with this size tubes using the tube system to transport RBC. I was unable to open John's procedure.

[Charging for multiple antibody panels]

Often we have to perform 2 or 3 panels including a selected cell panel while working up a patient's antibody. Currently we only result the antibody ID which has a bill code for one panel. Any ideas on how to reflect actual cost as well as record workload for productivity would be greatly appreciated.