applejw

Agreed - competency is very hard and we got through CAP Hybrid inspection this year and still got dinged because the review signatures on the summary page were not obtained within the competency testing period - competency due for 2020 signed in January 2021 even though the direct observations and testing were done within the 1 year period. Dismaying to say the least.

Our MTP protocol gives RBC and plasma through the Level 1 or Belmont and a second IV access is used for platelets

At my facility, the pharmacy and the Blood Bank collaborated in obtaining, storing, thawing, labeling and issuing the product. We did not have a standalone printer to create modification labels and our BB LIS considered it to be a pharmaceutical product. Pharmacy ordered the product after the patient's ABO type was available, shipped it to the BB for storage and thawing. Once thawed, the pharmacy picked up the product(s) and labeled the modified product and issued it to the patient infusion area. Fortunately, this has only come up twice in the last 8 years.

I can describe how it works for our healthcare system and PM a copy of our policy. The pre-hospital transfusions on the helicopter pre-dated me at this facility but I have expanded to ambulance pre-hospital transfusions on 3 ambulances with begging to increase to 4 ASAP. We maintain sets of 2 O NEG RBC and 2 low-titer liquid Group A plasmas for 1 helicopter and 2 ambulances that work out of the level 1 trauma center. We set up a dummy patient for each vehicle and units are pre-labeled for that dummy patient, segments are retained at the Blood Bank, each unit wears a Saf-T-Vue10 indicator and a triplicate Emergency Release form with unit numbers documented on the form with one copy of the form retained in the Blood Bank to keep track. Each vehicle uses the Pelican Biothermal Credo and changes out each blood product set once every 24 hours. The crew at the vehicle base is responsible for exchanging the cold panels for the credo. Each credo carries a datalogger and the datalogger report is downloaded and emailed to the Blood Bank at least weekly for review. Each credo is validated to maintain temperatures for up to 3 days prior to being released for active use. When a patient is transfused, the flight/medic crew is responsible for returning one of the copies of the emergency release form signed by the crew's MD to the originating Blood Bank and one copy goes on the patient's chart. Units are released from the dummy patient, crossmatched (if we get a sample), and transfused in the LIS to the actual patient. The crew returns to their base to replenish the units that were transfused. If the patient is transferred to a hospital that isn't part of our healthcare system, we still have a copy of the form returned to us and the crew will tell us where the patient was transported to and we "transfuse" the dummy patient with unit comments in the LIS with whatever information we received from the crew .

I suggest to my techs during training that it may be prudent to test the last wash before preparing the eluate - especially when additional red cells are not available. I'm sorry to report that I have seen several elutions where the last wash never became negative..... usually with cord cells where the mom had a VERY strong antibody - even changing tubes with every wash. I'm sure that if I had had the patience and persistence, it might have become negative but I gave up at 10 washes.

Our facility has built the attestation statement as part of the Emergency Released order set. We implemented this after our last FDA inspection in 2019 so don't have any feedback from them yet. We also use a triplicate form that documents the diagnosis, date and units that were issued during the process.

AABB Transfusion article from February 2019 discusses anti-CD47 interference and possible mitigation methods. It discusses how PEG adsorption may not be valid due to precipitation of the anti-CD47 which carries the risk of also precipitating out any alloantibodies rendering the tests negative (but invalid). It also discusses the blocking of antigen sites causing a negative or weakly positive DAT but a strong panagglutinin in the eluate. The conclusion was that multiple alloadsorptions using papain-treated red cells and use of Gammaclone anti-IgG may mitigate the reactivity. My question is whether anyone is using these methods for mitigation, were they successful, and how are you obtaining papain-treated RBC for the adsorptions? Can you use W.A.R.M (ZZAP) for the papain pre-treatment? I ask this because my facility is the 'reference' lab for a large hospital system but doing a 2-stage enzyme procedure is not feasible with my staffing and workload.

Change your setpoints to 2.5-5.5 - that way you are covered for both RhIG and blood products

Back in the 80's, had a cardiac patient undergoing CABG and received 8 units B NEG RBC during surgery. Three days later, a new specimen was received that typed mixed field AB POS with a reverse type group A. Supervisor retrieved the chemistry specimen from 3 days prior and it typed as A POS. Turns out the phlebotomist drew the patient in the other bed and this was long before second sample requirements .... Patient was a little "oozy" post-operatively but survived the experience. Same hospital, elderly female patient typed as O NEG. Blood was crossmatched and issued during the weekly computer downtime. As I went through the stack of units that had been issued updating the computer records, got a major flag as at computer issue - the unit was A NEG and that was just the first of 2 units that had been issued during this 2 hour downtime. Investigation revealed that 2 A NEG RBC were placed in the O NEG inventory, were crossmatched using immediate-spin and were compatible, and out the door they went. The patient was fine.

We use Pelican ProMed credos for carrying blood on ambulances and helicopters. To what extent to we need to go to re-certify these credos annually? Every payload includes a datalogger. Would it be acceptable to review temperature data during certain months, verify that the panels are within expiration dates and that the containers appear undamaged to consider them to be re-certified for another year?

We have 6 of the MaxQ MTP coolers and they work very well for us - we run over 225 MTP per year with a Level 1 Trauma Center and High-Risk OB. We keep liquid plasma and thawed plasma on hand and haven't had a problem with the validation. Biggest issue was OR runners going up and down stairs with them and not banging themselves up. I liken it to parking at the airport with your roller bag and not bruising yourself getting into the terminal. We also purchased the blood shippers and use them for inter-facility transport of RBC and plasma. We decided to go with the R-12 instead of the smaller R-10 (we couldn't get the validation where we needed it to be). We use Coleman coolers for platelets because the smallest of the blood shippers intended for platelets was the same color as the RBC shippers and didn't want any confusion.

I'm a huge fan of dedicated BB staff for larger facilities. Currently, only day shift is comprised of dedicated staff and 2nd and 3rd shift manned by generalists who work in at least one other specialty. With a 6 on/8 off schedule, some of the 3rd shift work only 1-2 days per month and are VERY uncomfortable given that we are a Level 1 trauma center, large outreach services and serve as the "reference" Blood Bank for 7 other satellite hospitals. Turnover is a problem on 3rd shift because of the extra stress caused by only being scheduled 1-2 days per month and being responsible for at least half of the massive transfusion activations. My Medical Director wants dedicated BB staff but with the current administrative/financial climate it is a steep hill to climb.

I'm back at this question and it's been over a year. Current discussion is whether to continue with Typenex bracelets for RBC transfusions or.... no Typenex bracelet requirement. We are in discussions with other facilities within our system who only use Typenex bracelet for patients who are unidentified or have other "identity discrepancies" - we are all moving to Softbank within the next 6 months. I'm looking for both Pro and Con opinions to bring to the workgroup. If you know of any literature on this subject, references are great. I would like for the group to make a system decision based on evidence and not feelings.

The requirement to perform a donor retype also plays into whether or not the LIS is used for electronic compatibility testing. AABB 5.16.2.4 The system contains logic to alert the user to discrepancies between the donor ABO group and Rh type on the unit label and those determined by blood group confirmatory tests and to ABO incompatibility between the recipient and the donor unit. * *FDA Guidance for Industry: Computer Crossmatch"

I highly recommend having a separate product build for convalescent plasma - enough so that it clearly distinguishes the order from a routine thawed plasma product. If you don't, beware of the possibility that a random donor plasma can be substituted for convalescent plasma especially if you don't have a lot of COVID19 patients receiving this product.