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We have just implemented this in Epic. Haven't gone through an inspection yet but I can't see that the FDA would have a problem with it as it is documenting a medical decision.

We have added the AABB attestation statement regarding the release of uncrossmatched, emergency released blood to an Epic order that is electronically signed. We still send a form but it is more of a back-up now for those instances where the MD did not sign the form from the OR and once the patient has been transferred, it is virtually impossible to find someone willing to sign the form after the fact.

Repeat testing used the cells that were originally placed on the Vision for compatibility testing . These were incompatible using the lavender-top tube but compatible when tested with the 2nd pink top. I think that, whatever the cause , the answer is found with the 2nd pink top tube. Two possible scenarios: 1) 2nd pink top collected from a different patient who coincidentally was also B POS and in the ER around the same time 2) Antibody titer decreased due to transfusion or dilution. At this point, it is a conundrum and might be academic but an interesting story. Thank you, everyone, for your thoughts!

So, this patient was initially seen as a trauma with an unidentified "identifier". The 2nd sample labeling was verified (by several people including myself) - collected at a different time according to the label. Patient's initial sample was B POS and this sample was also B POS. It is always possible that the second sample was collected from a different trauma patient in the ER that was also B POS around the same time but, because of the probability of another B POS patient in the same vicinity in the same time period, I don't believe that is the cause but cannot exclude this possibility. The hematology sample was also B POS. I did check other trauma samples received during that time and there were no other samples tested as B POS.

I initially thought that some of the antibody would be adsorbed onto the transfused positive cells but wasn't sure if that would be enough to completely remove the reactivity - but apparently it sure helps!

Situation - RBC and plasma issued emergently to patient. 2 units RBC and 2 units plasma transfused in ER. Testing on patient specimen drawn pre-transfusion showed 2+ reactivity with screening cells and anti-K1 was identified. When performing compatibility testing, the 2 transfused RBC were compatible when tested on the Vision using a 2nd specimen collected after the original specimen used to perform Type and antibody screen (insufficient plasma remaining from pre-transfusion specimen to perform any additional testing). After performing antigen testing on all units, unit #1 was tested as K1 positive and unit #2 was K1 negative. Compatibility testing using manual gel technique was performed on unit #1 to verify the negative test result - but was found to be 2+ incompatible. This testing was performed using a 3rd specimen collected at the same time the initial specimen was collected (CBC specimen obtained from Hematology). This was repeated on the same Vision instrument and was 2+ incompatible using the CBC specimen. Is it reasonable to assume that the plasma transfusion (along with associated IV fluids used in resuscitation) would have diluted the existing antibody enough to yield negative test results with an incompatible RBC unit?

We routinely test cord blood samples on Vision. We do not autoverify results from the instrument so are required to check results before crossing over interface. Requirement to perform weak D testing is verified on daily work review.

Update: Blood supplier now short on blood transport boxes - especially platelets.

We are in South Carolina.

Today, we received notification that our blood supplier will no longer be entering the hospital building. We are expected to meet the courier outside to take delivery of the shipment. Additionally, we will be charged for each of the shipping boxes since they are no longer going to be re-used. Has anyone else encountered this as part of our brand new CoVID-19 world?

When do you perform an elution? (e.g. all positive DATs, all positive DATS within 3 months of transfusion, IgG positive only) Positive DAT with anti-IgG if being tested as part of transfusion reaction investigation or antibody identification or at physician's request. Positive DAT with neonates are called to the provider and eluate is required if no history or Mom has positive antibody screen or there is no ABO incompatibility between baby and Mom What method is utilized for the elution? EluKit II What method is utilized for testing the eluate? Gel or modified AHG in tube How is the eluate tested? (e.g. screening cells, full panel, specially selected cells) Full panel unless sample size is limited then perform a selected cell panel Feel free to mention any special notes/criteria for which I may not have though to ask. I prefer gel but sometimes tube is cleaner. Some of my techs have a problem with anomalous gel results and I think it is due to stroma contamination.

I added a statement about either not transfusing or splitting units for patients that are at risk for circulatory overload and that it was the provider's responsibility to identify patients who are at risk . We use Epic and after the last JC inspection, transfusion rates were amended to specify urgent, normal or slow rates at the time the transfusion order is entered.

Just saw this topic - we are 700 bed facility with 35 bed NICU and are the Mother Ship to 5 satellite facilities that offer Labor and Delivery. We probably do 1-2 per year and they seem to come in clusters. More often than not, there is a panicked phone call ordering exchange transfusion STAT before Bilirubin levels and Hgb are performed. Did I mention that we are also a teaching facility? After calling in someone to perform the reconstitution, it is usually cancelled because phototherapy was initiated and the bilirubin levels dropped below the "Exchange Transfusion" threshold. Other hospitals I have worked at had similar rates of exchanges for infants.

My director has requested information about how other comparable hospitals train new employees so I thought I would try this group to get a handle on length of training. We are a 700 bed hospital with 6 satellite facilities - 5 of which send us their antibody identifications. We have 2 Ortho Visions and irradiate our own blood products. We have a 30-40 bed NICU and transfuse very sick premature infants. We do not wash or deglycerolize red cells. We are a Level 1 Trauma Center performing upwards of 150 Massive Transfusion activations per year. We transfused approximately 29,000 blood products last year. Day shift is staffed primarily with MT that work only in Blood Bank; 2nd and 3rd shift is comprised primarily of MLT that are generalists and rotate coverage throughout other areas of the laboratory. Our existing training period is 6 weeks with the last week being skill assessment. Based on our most recent experience, we have asked leadership to make the training program longer than 6 weeks to give the new hires the best chance to succeed and to prevent failure with our patients. The most recent hires have been new graduate MLT (some have yet to take the ASCP exam) and MLT/MT that haven't been exposed to Blood Bank theory and practice for a long period of time. Most of these "experienced" new hires have not worked in a facility of this size and complexity. Any thoughts or opinions on an appropriate training period for Blood Bank newbies?

We have Soft and Epic and are a level 1 Trauma Center with approximately 175 activations each year. We pre-label MTP cooler #1 for either Male or Female to a dummy patient (Patient, Massive T) and have a 3 part form to document units on (6 RBC, 6 plasma and 1 platelet) along with the Emergency Release attestation that requires a physician signature. The first cooler is almost always issued on paper but can be scanned into Epic using the MTP flowsheet (NOT part of BPAM). Additional units are set up using Emergency Issue with a one step Issue process that prints XM Labels and downtime transfusion records if needed. In order to streamline the issue of this cooler, it is protocol to only document actual patient trauma ID on the 3 part Emergency release form. Cooler contains 6 Group O RBC, 6 Group A plasma and one platelet of any type. Nursing or anesthesia can scan unit numbers into the MTP flowsheet or use an anesthesia workflow from Op-Time to capture scanned blood products in the operating room. It is not a perfect system and takes some education for the users and we still have problems with documentation and we are 3 1/2 years since conversion to Epic/Soft from Soarian/SunQuest. For straight emergency released units from one of 2 remote storage refrigerators, ER nursing can scan unit numbers into an Emergency Released flowsheet for either RBC or plasma. This actually works really well and is widely used by Trauma staff members before patient moves to OR. It is a simpler version of the MTP flowsheet.

I received the same notification yesterday and asked my Quotient rep as the IFU being shipped is the same January 2019 revision as is on the Quotient BD website. The answer was to call the Ortho Customer Service line to ask for the date of the future implementation. The original notification is dated May 2, 2019 for an August 2019 implementation. The timeline has obviously changed to some future date which is not being disclosed at this time.

We recently had baby with strongly positive DAT on cord blood, Mom and baby both Group O, mom had a negative antibody screen at delivery. So, per policy, did eluate and identified anti-Cw in eluate. Went back and tested mom - who had unidentified anti-Cw demonstrating at delivery. Our screening cells do not routinely have cell positive for Cw antigen. Textbook case. We routinely call baby's location when we have a positive DAT on a cord blood evaluation. This is at the request of the physicians so that they can order a Bilirubin sooner than the routine 24 hrs post-delivery. This was after many meetings with Risk Management, OB physicians, pathologist, nursing, etc..... This is NOT considered to be a critical value notification. We call it "abnormal result notification".

We keep RBC and plasma on our helicopter using the Pelican Credos and a datalogger. Units are changed out every 24 hours or replaced when transfused and they keep extra sets of credo panels in the ER freezer to follow manufacturer IFU. Dataloggers record temperatures every hour with an audible alarm to the user if the temperatures exceed 6C. Datalogger data is transferred to the Blood Bank for review and retention. We are looking into keeping units with supervisor units for ground transport in 3 counties but that is still in the works. If you can install an undercounter BB refrigerator at the airport with Wi-Fi temperature reporting and 7-day continuous chart recording, that may be another route to investigate. I have worked at a facility with remote storage at the heliport that was maintained by both ARC, hospital and air ambulance services. All have to work together to meet requirements to ensure that blood products are maintained properly.

I have had this conversation numerous times with Anesthesia manager - do we really have to have 2 people verify? Yes. Stop asking. As for scanning, we have Epic BPAM which does not function in the OR. OR has their own process that does allow scanning of units during massive transfusion but it isn't perfect. If they scan the units from the cooler and somehow the unit isn't transfused and is returned to the BB, there seems to be a glitch where unit status in Epic thinks the unit was transfused when it actually was not and did not update when returned to the BB. Later, when trying to scan for another patient, BPAM gives a warning "Unit not intended for this patient". This statement is an almost guaranteed nurse "freak-out."

I understand the logic of the Typenex as a 3rd or 4th identifier that links that specimen to the unit of blood. But, I am living with the issue of getting 10,000 nurses to be able to complete a Typenex specimen label and Typenex bracelet correctly. It just is a problem. Biggest issue with specimen labeling is forgetting to add the Typenex label that says "Place patient information below this line and attach to specimen" - it just doesn't happen. I don't know why it's so hard, we have powerpoint education, it's a class in Orientation where they hear it and see it then do it and the report back is that, even after just talking about it, 75% of orientees fail the test of labeling a specimen and bracelet correctly.

Not advertising but there was a good podcast from BB Guy this month on implementing use of low-titer WB at University of Cinncinnati and their experience from both trauma and blood center perspective.

If there is anyone who has implemented the use of Group O LTWB for trauma that would be willing to share SOP? How are you monitoring recipients for adverse reactions to incompatible plasma? What types of patients are approved to get stored WB transfusions? What happens to the unit if not used - do you manufacture RBC or waste the units? Do you use O+ or O Neg (or both)? Do you have a set limit on the number of units a patient can receive while the ABO/Rh type is unknown? My trauma surgeons are pushing hard to move forward with the plan to implement, blood supplier is willing to provide product but I have lots of questions and not a lot of resources and don't want to reinvent the wheel.

My interpretation is that containers used for transporting blood products must be validated to ensure that the blood products are maintained at appropriate temperatures including extreme ambient temperatures (winter and summer). This validation would need to be done by the blood supplier since it is their container that is used for the transport and would be verified by the FDA during their routine inspections of blood manufacturers. As a recipient of incoming critical supplies (blood products, reagents, etc...), I must have established criteria that are used to verify that the incoming products are acceptable. If my criteria include measuring the temperature of all or part of a blood shipment, then that needs to be performed at the time the shipment is received. My blood supplier must pack products to maintain the correct temperature for a reasonable time period so that, should I choose to measure it, the units would be at the appropriate temperature.

Agreed. We had a recent positive DAT on Group O baby born to Group O mom with negative antibody screen. Eluted anti-Cw. After we went back and tested Mom with Cw + cells, 3+ reactivity. Actual practice on testing babies varies from hospital to hospital - and I think most is dependent on the volume of deliveries at that hospital and the Blood Bank workload.

Our admit order set includes performing Newborn Evaluation when Mom is group O, no prenatal care history, or history of positive antibody screen. Almost 100% moms have an admission ABO/Rh type and antibody screen. If mom has a negative antibody screen, what are we expecting to find when performing a DAT on ABO identical mom and baby?