EDibble

Looking forward to your posts.

That was my thought too.

Exactly Scott, we have many patients who are "snowbirds", spending the warmer months here in New England, the head down south for the winter. We have no idea of their transfusion history away from here, and often are not very reliable upon questioning as to where / when they were transfused. Other local patients seem to like trying out different hospitals (we have about 5 within 30 minutes of each other). We sometimes call them "shoppers".

Same as us Cliff, but we have a 21 day policy.

Fascinating study. Thank you for sharing.

Welcome back David!

I agree with Malcolm and David. Have seen this several times.

I attended the MABB this Spring and sat in on this presentation. Very interesting indeed.

Forgot???? That is inexcusable.

Have you informed Immucor? They might want to research a recall. Or at the very least you might want to request some replacement strips for the "wasted" ones. How many have been wasted?

It is not the lab staff I don't trust, it is other people.

Thank you for that. I am going to save it for Lab Week next year.

I totally agree. We see this here all the time. It is not a problem with the ECHO, it is usually a non specific ab reacting to either the stroma or the "glue" used to bind the stroma to the wells. We have a great flow chart now and it has cleared up 99 percent of the confusion. Beth

We have been going round and round on this topic. Is there a requirement that blank anagram sheets for outdated panels be kept for any length of time? Of course I am talking about panels that have been physically discarded, not outdated ones kept for ruling out. The paper records for any patient that gets worked up and has an antibody are kept in binders if we need to refer to them in the future. FYI, we are currently CAP accredited, but not AABB. Thank you, Beth

I can now report that *all* significant patient information on our old cards has been entered into our LIS. NO MORE CARDS! Welcome to the 21st Century!

That is what we are doing even as I type this.

I know that we get duplicate testing ordered here when one hospitalist does not see that another physician has ordered tests, and orders them again.

As several others have mentioned, our facility used to separate samples. Then the issue of mislabelling the aliquots came up, not to mention the cost of the pour off tubes. We saved money and kept the patients safe at the same time! Beth

We have had similar experiences here David. There are times when a physician will only accept an answer they don't want to hear from another physician. "What do you mean we have to get blood from across the country for my patient?" et. al. Beth

"When i say they brought it back to the blood bank, they walked into the blood bank but my tech did not take the blood, the nurse had the blood when he walked in, and it never left his hand and he took it back to the floor." Keep in mind that I am a cranky old Blood Banker, , but if that unit came back in someone's hands and had been spiked, I would not let them leave with it. Like the seagulls in the film "Finding Nemo" MINE!!! Beth

Really interesting article. Thanks!

Mini rant. We have compliance issues too, but what really sets me off is when the transfusion paperwork comes back (as our policy requires) for a transfusion reaction, and vital information is missing. And, whenever I have observed a transfusion starting, the nurse times it when the blood enters the patient, so at least that is being done correctly.

Great questions. We have had the ECHO for many years now, and see this phenomenon fairly often. We have a flowchart to determine the steps to take. This is the short version: If the patient reacts on the ECHO in all screening cells, and they have no antibody history, we do an ECHO panel. There could be an antibody to a high frequency antigen, or a mixture of multiple antibodies causing all screening cells to react. If the panel is also all positive, we do a tube screen and Auto with PEG, our backup method. If the tube screening and Auto are negative, end of story. Report screening as negative. Even Immucor says they do not know why this happens with some patients, but the most recent theory is that these patients react with the "glue" that holds the rbc antigens to the walls of the sample wells. I am very concerned about your coworker's thought process. You are absolutely correct that a newly developing antibody, or an old one with a low titer can react with the Capture method and be negative in tube. Just running tubes to "make the reaction go away" is very dangerous. Almost always, a patient with this non specific type reaction will react in all the wells of a capture strip. Good luck, Beth

Under such circumstances, we would generally give only Rh and K matched blood (well, and ABO matched, of course!), rather than match for other antigens. Malcolm, I am so glad that you added the ABO comment there. ::Whew!!!::