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We will require this when we go to electronic crossmatch and this is how I understand we will be doing it. The first draw is done by a nurse or phlebotomist. The second draw would be done by a phlebotomist. Usually, from what my supervisor says, they will be having a CBC done again before transfusion if it isn't emergent (from her experience). We would issue O cells until the type is able to be confirmed by forward and reverse if we are unable to get a second specimen. It would be my assumption that this will usually be done when the patient first gets to the hospital and at that point they are too tired of being stuck and less likely to complain. The blood bank tech is the one who looks to see if there is history on file and if it matches the current sample. The blood bank would also be the ones adding on the type confirmation test. I hope this helps. Brenda

We do a type recheck which is the forward type and IS XM or AHGXM if indicated.

I do this very often as well! I have gotten out of the habit of answering the phone like that at home though!

If you keep track of what well you put it in then you could take it out during the day so it doesn't get broken.

The best thing you can do with those results is call the lab that reported them. They do not make sense to anyone outside of that lab because they look like "canned" results. If you have a copy of the reports then your Dr. approved you to have them and they should be able to help you interpret what was meant by that.

I just took a second to look at the date that is at my workstation and it is from.... 1989!!!! We do have a second one that is from Biotest dated 2005. Phew!

Thank you Malcolm and the gang! I appreciate it!

4+ is our strongest reaction but with the biotest reagents we don't see 4+ too often. The reagent seems to be a little weak. So a 3+ would be considered a strong reaction. With that being said would you think then it is more likely she is losing her D antigenicity? That is interesting! Thank you by the way for the guidance I am glad to have "met" you!

The DAT was negative. We do not have any enzyme treated panels. We are not in any way a reference lab... we usually send the difficult stuff out. I got a little excited when I saw the cord blood experiment I could try. Her red cells reacted with a 3+ in the biotest tube reagent. She is registered as "White". We have not ever transfused her but we already know that means nothing. She has breast cancer as her diagnosis and she is 73. We did the TS because she was to receive platelets so we didn't HAVE to go any further. My supervisor has put in a note to transfuse Rh neg cells for now. I believe she is thinking mosaid or partial D. oops forgot the pregnancy one... I am not sure but I would assume she has been.

We just this week had an A pos patient with what looks like and Anti-D. She has never been given Win -Rho so they say. I tried the O Neg cord blood to see if it was Anti- LW. Much to my dismay it came up negative. I have never wanted a positive test so much in my life! lol

We have had a problem with very weak reactions however, I don't think there have been any false negatives.

Congrats on your SBB!

If the plasma has leaked you will know it. You should be putting it into an overwrap bag too. It the bag does break and leak then you change the water at that point.

We keep a record of changing the water monthly for our brand. (open system) I believe at our other campus which is a closed system it gets changed every six months.

The only reason to pool the units would be to please the nurses.... You are still exposing the patient to a lot more donors which I wouldn't like as a patient. If you could get ped. blood that all came from the same donor that would be the best way to control your inventory. You could give out the 4 or so separate units but only expose them to one donor. As far as pooling we are getting as far away from that as possible. There is too much risk of contamination. I would say tough to the nurses!

It could be an interference of medication. If you have a technical manual from AABB it explains that a lot of medications may interfere with coombs testing. In our institution the Dr. would have to sign that the patient's life is in danger and he needs incompatible blood. It usually works out OK for our patients they receive the unit and are fine but I would definitely make sure the RN watches the patient's vitals.

We only do weak D testing on babies.

I am very sorry for your loss.

We are in the process of building our soft system. I am very excited because we used to have soft and went to Cerner... Cerner is awful!!!!! Now we are getting soft back. There are some things that have improved in the newest version of Softbank. You can access the patient in certain areas when someone else has them up. Having the BBID mandatory on all patients is a parameter I think. I HIGHLY recommend Soft!!!!!!!:hooray::hooray:

Also, what about units issued in a cooler that stays in the OR? Isn’t that storage? Looking forward to the responses...

Cindy2008, what system are you using for blood bank?

I am in favor of doing type and screens on all L&D patients. That is what we do at our hospital. These ladies can lose lots of blood in a short amount of time and to have to do the type and screen at the last minute when the Dr.s are screaming is not a good thing. Also, they are pregnant, they can develop an antibody at any time. Our Medical Director is very much on board on having T&S on every admission. Also, if you are going by history of another lab, they got the type wrong, the patient should have gotten RhIg and never did whose fault would it be? That is enough reason for me to do a Type and Screen on every L&D that walks through that door.

I wouldn't say that you always have to give E neg cells. If you can rule it out then you don't have to bother but each time he gets blood that will change. If you can antigen type him that would be good. If he is E pos then you do not ever have to worry about anti-E. I hope that helps.

At our facility we have all mothers get a type and screen when they come in. All babies have a cord blood collected and they are all sent to the blood bank. When the cord comes to the bank we check to see if it needs to be tested and will call labor and delivery for a cord blood order if there wasn't one in the computer. We then put it upon the nurses/doctors on Mother baby to be aware of the mother's type and the need for RhIg. We also try to make sure that the mothers have the fetal screen done too. We do this mentally... there is no real tracking. I think that since the day shift techs do most of the mother and baby testing we really have a handle on who needs to get RhIg. Actually the evening and night shifts don't do any cord blood testing they save the cords for days to put away and at that point we check them. There are a few cords that don't get collected but very rarely since it is so routine for them to be collected on every patient. We also used to do just a Type on all mothers and add a screen if they went for a c-section. We recently changed this because by the time they are going to surgery it is really too late to start the screen if it is a true emergency situation. I really recommend doing a type and screen on every mother considering we know they will all bleed to some degree.

Thank you for the info THintz. I will keep that all in mind.