silverblood

If hazy reactions occur in Ortho Gel card antibody testing what does this signify? Would a hazy reaction be considered a positive or false positive reaction and how would one proceed to resolve this problem? Would one proceed to a gel panel or first use another method ( i.e. tube testing) ? How would one report such a reaction?

The only product that our blood bank handles is the RhoGam (Rh immune globulin-intramuscular)-all of the other products on the list are handled by pharmacy.

Our facility has a free-standing E.R. at another location that is required to have 2 units of O neg RBCs on hand at all times. We receive O neg units in at our main hospital facility and do the retype. The O neg units can then be transferred out of our facility to the free-standing E.R. site-the unit is put into a 'quarantine' state at our main hospital. We have a 'transfer log' that has to be filled out detailing the unit # and when it was sent and the temp. when sent etc. The free-standing E.R. site has to document when they received the unit and the temp. etc. If they need to use the unit they need to change the status of the unit form quarantine to available. If they do not use the unit within 7 days of it's expiration, the unit is returned back to our main hospital site with 'transfer log' documentation completed. The unit is then taken out of quarantine and made available again for use at the main hospital site. We do not have to retype the unit again as we are able to show tracking of the disposition of the unit at every step along the way. I have another question for you-why would you send a unit someplace else to be irradiated instead of just ordering an irradiated unit directly from a reference lab site? This is how we handle obtaining irradiated units-they come to us from our reference lab.

Our facility has used a separate identification band for patients who are going to be transfused or who may be transfused. This would include patients who come in pre-surgically to have their pre-surgical lab work done. The patient is requested to keep the blood bank identification band on for when they arrive at the hospital for their surgery. We also have an 'infusion center' where patients come in to have infusions as an outpatient procedure-for example, chemotherapy patients who may need blood or platelets. These patients are also required to arrive at the hospital for their procedure with this band on. As inpatients, a blood bank is attached to the patient with their first blood bank order (i.e. type and screen and/or crossmatch) and this band can be used for this patient throughout the admission. If the blood bank specimen expires (72 hours) the patient can be identified for further blood bank testing using this blood bank I.D. number-in this case the blood bank I.D. number is written on the new sample that is drawn. We have very strict rules regarding these bands and who can draw blood bank samples and who can or cannot remove blood bank bands from a patient. Floor personnel and phlebotomists cannot remove a blood bank I.D. band until blood bank is notified. I have worked at this same facility for 35 years now and this system has worked very well for us. We have never had a case of a unit of blood being given to the wrong patient and have never had a 'sentinel event' involving any blood bank issue (mistyping, wrong patient drawn and misidentified etc.) I would really hate to see this method of identification eliminated at our facility just because this extra level of security is considered cumbersome or time consuming. Safety is always the way to go in blood bank as far as I am concerned.

Our hospital is soon converting to Cerner LIS from MediTech. With the Meditech system we were able to print transfusion forms that had sticky labels printed with the forms which we would affix to the unit of blood or blood product. These labels would be printed with all of the specifics about the unit: patient name, donor unit #, blood bank I.D., medical record number of patient etc. With the Cerner system we will no longer be using these transfusion forms-apparently the only thing that will print with each unit is a paper that will have all of the unit and patient information on it-there will be no label to affix to the unit itself. I'm told that this 'paper' will somehow be attached to the unit to be sent to the floor for transfusion. This does not seem at all feasible or safe to me. Wondering how other facilities that have the Cerner LIS handle this situation. I shudder to think that units of blood may be going to nursing units with only a piece of paper attached to them as the only identifying item................

At our hospital we would report out the transfusion as 'least incompatible' and require teh ordering physicians signature on designated form before units would be allowed to be given out. If a physician is not available the form can be signed by two witnesses-one who actually heard/witnessed the ordering physician indicating his o.k. to give blood product that is not entirely compatible.

We also love our DxHs but have not gotten to the point of using them for body fluids. Of course, we would like to do so. Can you shed some light for me on what kind of correlations you had to do?

We've been aware of the anti-E issue for some time now. If we suspect anti-E becuase of the pattern in the screen or if a patient is already known to have anti-E we will incubate the panel longer (instead of 15 min. we will take it to 30 mins.) Also, it'smy understanding that panel B is more specific for the Rh antibodies. NOt sure our Drs. would like 'miscellaneous antibody' either-new medical director is coming soon who will hopefully help solve some of these issues for us. Sounds like we may just need to standardize our method of reporting.

Our policy is to give O blood to patients who type as A2-this has been the recommendation of our reference lab also.

At our hospital we us the Ortho MTS Gel system for our antobody screens (3 cell) and antibody identification panels. Occasionally, we will have the experience of having an antibody screen that is positive but when we proceed with the antibody identification panel results are either all negative or inconclusive. Some techs here feel that in this case the antibody screen should still be reported out as positive and the antibody identification (of course only after having done all rule-outs-correctly I hope!) should be reported out as 'all clinically significant antibodies were ruled out' Others feel that in this case the negative/inconclusive panel result should be followed up by a tube screen. If the tube screen result is negative the antibody screen would then be resulted out simply as negative-of course specifying that the manual tube method was used. Of course, if the tube screen result was positive then further investigation would be needed. I have had numerous calls from physicians who do not seem to understand what the term 'all clinically antibodies ruled out' means-if an antibody screen is resulted as positive they want to see a spcific antibody result. I have seen some even cancel scheduled surgeries as they feel this indicates a questionable report. This has been a subject of controversy at our hospital for some time now-I would appreciate some input from others as to how this would be handled.

Our laboratory has purchased a new Coulter hematology analyzer-I've been told that we need to do a 'mixing study' to evaluate how long the EDTA samples shopuld be mixed before placing on the instrument. Does anyone know of a procadure for this or where to find this?

Our hospital no longer does weak D testing except on Rh neg. babies with Rh. neg moms to determine need for RhoGam. We would issue Rh negative blood to this patient.

I am wondering what your reasoning is for performing a HGB on cords with positive direct coombs as I have never heard of this being done. I would hate to run those cords through our hematology instrument as so many of them have clots......

We have been using Ortho gel technology for quite a number of years. When we switched to the gel we started using the pink top tubes. However, the pink top tubes are also EDTA tubes with the same formulation as a purple top tube. So in reality, you can use either the pink top tubes or a purple top tube. Our preference is the pink top tube specifically because we can get more volume-7 ml. as opposed to only 5 ml. or 2.5 ml. (short draw purple). Our only complaint about the pink top tubes that sometimes when stored in the refrigerator the plasma seems to build up some kind of precipitate that in some cases interferes with reading reactions. For that reason, if we need to pull a sample out of the refrig. for a subsequent crossmatch or other testing we will leave the sample sit at room temp. for a while (if possible) or put it in the heating block for a few minutes or centrifuge the sample. We have never been able to get any explanation for this little idiosyncracy of the pink top tubes.....................

Just to settle a dispute-I am wondering what other hematologists' definition of a smudge cell would be. Some techs. in our lab contend that a smudge cell can be defined as any cell that has been disrupted................Others feel that the term 'smudge cell' refers specifically to those fragile lymphocytes such as those found in CLL that addition of albumin before making a slide can resolve. What is your opinion?