Deny Morlino

You never cease to amaze Malcolm!

In this situation we still classify this as incompatible since the identification is incomplete. The physician signs a release of the unit indicating that counseling of the risks involved have been explained and the responsibility and liability now lies with them.

Make and stain a smear looking for platelet clumping. If present consider a recollection advising phlebotomy to collect a sodium citrate specimen in addition to the normal EDTA specimen in case of EDTA sensitivity in the patient. If the recollected EDTA specimen still demonstrates platelet clumping, run the citrate sample and correct the platelet result by multiplying by 1.1 for dilution correction.

Make and stain a smear looking for platelet clumping. If present consider a recollection advising phlebotomy to collect a sodium citrate specimen in addition to the normal EDTA specimen in case of EDTA sensitivity in the patient. If the recollected EDTA specimen still demonstrates platelet clumping, run the citrate sample and correct the platelet result by multiplying by 1.1 for dilution correction.

Thanks for the responses.  I've discovered over the years that blood bankers love to live in the land of "What If".  You can be confident that I own a large home right in the middle of that land.    
 
I'm finding that patients are taking a more direct hand in their care and are much more knowledgeable than they were 30 years ago.  While info from a patient should be confirmed if possible, much more often than not they are reasonably correct if not complete in their info. 

I'm a big believer in this and it's something I stress when training new employees and students.

We had a case recently where a patient came in through the ER, she gave the nurse an Antibody card for a Jka that was identified years ago in Texas. When we called to get more info we were told that the patient was not coherent and no family was available.  We did the screen (positive), and antibody Id and found a E, K (no sign of the Jka).  2 units were set up(E,K,Jka neg) and transfused.  The next day they ordered 2 more units, a nurse from the floor called to say that the patient was insisting she had another antibody card that she could not find.  I spoke to the patient and she told me she had 2 cards from different hospitals, she was also able to tell me all (or at least several) of the hospitals she had been transfused at.  I proceded to call all of them and found another hospital in Texas that had identified E, c.  We antigen typed the units she was given and 1 was c positive.  Post transfusion had a lovely c.
 
Morale of the story...Always listen to the patient....

For reasons such as this, whenever I have a positive antibody screen on a new patient, I call the floor and ask if the patient has been transfused before and, if so, where.  I then call that facility and get their history.  In transfusion medicine, we have to be investigators who are willing to turn over every stone. 

I would antigen type the patient. If K negative, we would transfuse with K neg units (easy enough to find them). We would probably add the Anti-K to his account with a note that it came from the patient.
A couple years ago we found an Anti-E and Anti-c on a patient and prepared compatible units. When we were getting ready to issue them, the nurse called and said the patient would like to speak with us. I went up and she told me that she had "antibodies, but doesn't know what that means, and she had a horrible reaction many years ago". She insisted I call the hospital where she received the blood, even after I assured her that we found the antibodies. I called the hospital and they had Anti-E, c, and Jka. WHOA!!! Ever since that lovely lady was insistent, I listen to patients.

If the information comes from the patient verbally, I usually try to verify the information from the facility that identified the antibody if the patient knows where it was identified. 

Fresh sample for us on admission. Over the years, I have seen too many patients answer NO to the standard questions and found they have recently been transfused in another hospital "Oh, I though you meant here in this hospital." I have never run a retrospective risk assessment on it though. Might be one for when I am short of work (LOL).
Cheers
Eoin

If you want to use concatenation (reading two bar codes at one time) with your bar code scanners the space between the DIN label and the ABO/Rh label must be the correct width.
I set up concatination using labels I printed from my Hematrax system and then when I tried to scan actual units from my supplier the space between the labels was incorrect and would not read correctly.

The only thing that I would say is that not all antibodies develop at the same speed.
Just because there was, for example, an anti-D present when the pre-admission sample was taken, does not mean that another specificity, for example, an anti-Jka, may not have developed by the time the patient comes in for the surgery.
Personally, I would want a fresh sample to test upon admission.

EXACTLY! 

It was confirmed to me by a few inspectors that it is valid to use the electronic probe activation as long as it is fully validated.
So when I purchased the refrigerators, I validated that it was accurate by comparing results of the manual vs. electronic probe activation.
Daily, we check the HI and LOW alarm activation, make sure it alarms at 1.5 and 5.5.
Quarterly, I check the probe temp against a certified thermometer.
I am also able to show inspectors from my wireless temperature monitoring system that it activates the alarm condition at those temperatures.
So far I have had no concerns from any inspector.

I do a thermal challenge for high and low alarm activation once a year and use the internal electronic check quarterly. No problems with inspections the past 8 years.

I have tried that many times in various places...but oddly, just as with many other aspects of Blood Banking, they don't seem to see the issue as being as critical as we do in the Blood Bank (don't understand possible patient ramifications). Like where I work now; that they must have 3 identifiers that match "exactly" in order to link a patient. I am sure that in their mind, that is their way of being extra diligent. However, if no one ever made clerical errors, this wouldn't be an issue in the first place.
Brenda

 

Hello: 
 
I don't know if your Blood Bank Computer System supports HemaTrax (on-demand ISBT128 compliance labeling), but if you have HemaTrax the new UNITY version now being validated by the LIS companies supports the printing of antigen information in the lower right corner of the 4" x 4" full face label,, 4" x 2" or 2" x 2".
 
Richard

Would not work here either, since the same BB armband is used over and over as long as patient is in house. Specimen numbers change, but the BB number links the patient to the current admission on the BB system. We generally don't like changing armbands if we don't have to. Too many oppourtunities for mistakes.
Scott

Are you referring to paper logs, electronic logs, or both?  For paper logs, an overlay template with the areas to be filled in cut out of the template is a handy tool (nursing loves the one the have here for checking completeness of transfusion record).  If you are talking electronic records, most software systems have reports available that can be custom defined and saved so that minimal changes (i.e. date ranges) are necessary.
 
As far as training goes, buy in by the people reviewing is paramount to success.  If the reviewers are just going through the motions, failure to catch all the omissions is likely.

Are you referring to paper logs, electronic logs, or both?  For paper logs, an overlay template with the areas to be filled in cut out of the template is a handy tool (nursing loves the one the have here for checking completeness of transfusion record).  If you are talking electronic records, most software systems have reports available that can be custom defined and saved so that minimal changes (i.e. date ranges) are necessary.
 
As far as training goes, buy in by the people reviewing is paramount to success.  If the reviewers are just going through the motions, failure to catch all the omissions is likely.

Great advice from everyone!
 
Eoin - I am stealing your idea. I think it could work for me, too. 

Hi Kathy,
We too have rotation of non-dedicated BBers through the dept. We do have BloodTrack as a good tool for tracking not only the blood, but the actions of our scientists. I have just read a good article in TRAQ on "nudging". I have followed up with other reading (plenty of references in Govt, financial world etc) on the subject.
I have for a while been keeping a matrix, with names on the vertical list, error types on the horizontal. I complete this for each month (for those found or reported to me). I then anonymise for all other staff members (keeping just the name of the one you give the matrix to). This is done for all staff and they can easily see if they are outside the norm. This has lead to a kind of competition among staff (so I have been told) and this has "nudged" them into better compliance with requirments. I try to keep them to really important requirments, but will consider expanding to other niggles (like not doing daily QC' on a new batch when old batch is likely to run out on next shift).
 
Bit of work, but I have found it worthwhile.
 
I do the same with minor specimen / form errors (labelling, lack of information etc) from around the hospital  - and graph shows a definite reduction in non-compliant requests / specimens after its introduction. Majors go through the CAPA system.
 
Cheers
Wayne 

Kathy,
I can sympathize.  Add to the headaches the fact that we do not utilize a blood bank module, so everything is paper!  My experience having generalists is that they are apt to forget details as they do not work exclusively in one department and remembering all the details is practically impossible.  Things that are common across other departments (like the lot number changes) I would be more irritated by since this is an integral part of the job.
 
Examine your processes to see if there is any way to streamline things for the generalists (it has helped me at times).  Sometimes you can spend more time "catching" the inconsistent errors than taking the issue as a whole and handling it (day shift reviews all charges here for this reason).  Encourage people to leave detailed notes attached to paperwork they leave out, or put the paperwork away.
 
Yes, it is like herding cats at times!  Hang in there and find a rhythm that allows you to be productive and not spin your wheels feeling as if you are chasing details all day.

A platletpheresis unit must contain a minimum of 3.0 x 10^11, so I think you would need to be concerned about the residual platelet yield after you removed a portion. At the very least it seems like there should be some QC of the remaining product to be sure that it still meets the criteria. True, many units would contain considerably more than the minimum and might pass, but some may be close to that minimum and would fail after removing a portion. At our facility, we do ocassionally remove small aliquots from apheresis platelets for neonatal transfusions. We do not use the remainder for adult transfusions. For this reason and the reasons listed above I would not recommend this practice.