MsDuffy

Hi Everyone! I emailed my post to ICCBBA for their answer on my conundrum and here it is for those of you who are interested. "The Final Content attribute (e.g., >=200mL<400mL) refers to the volume of the final product. So if the final product is an aliquot less than 200mL, then this attribute must either be omitted OR it can be replaced with another Final Content attribute that is consistent with the final volume of the aliquot (e.g., <200mL, <50mL, etc.). Your vendor and its system are correct. The product code itself that your blood supplier is using can be a correct code only if the actual volume of the unit is consistent with the Final Content attribute. So if the A0 unit had just over 200mL and the B0 unit had just under 200mL, then the B0 unit cannot have the “>=200mL<400mL” attribute but the A0 unit would be fine. The bottom line is that the attributes must be consistent with the final contents of that unit. Please let me know if you have any further questions. Thank you. Regards, Erwin Cabana Information Standards Specialist ICCBBA"

Thank you for your response. Could you share your reference for your answer? The United States Industry Consensus Standard for the Uniform Labeling of Blood and Blood Components Using ISBT 128, Version 3.0.0 Draft R (March 2011) seems to allow for either practice, but all of the examples are of product codes NOT utilizing volume Final Content modifiers. Everything that I've read thus far suggests that if a blood supplier is going to utilize the volume Final Content modifier, and it isn't required that they do so, than the label must reflect the accurate volume of the product that is in the unit that is distributed.

We have run into a situation that is causing us a big headache and I'm looking for feedback and assistance, if possible, in determining the correct answer. A blood supplier is labeling divided products intended for pediatric use with Final Content volume modifier information that is not consistent with the volume of the final product that is distributed. Specifically, they are manufacturing an Apheresis Fresh Frozen Plasma (E0940 - Apheresis FRESH FROZEN PLASMA|NaCitrate/XX/<=-18C|>=200mL<400mL) and then further manufacturing it into four divisions intended for pediatric transfusion. They are labeling and distributing the four divisions as E0940VA0, E0940VB0, E0940VC0 and E0940VD0. Our computer system will not process these units as the volume of the product that is shipped to us is <200mL and the Final Content volume modifier associated with E0940 is >=200mL<400mL. The system is balking at the discrepancy between the actually content of the unit received and Final Content volume modifier. The computer system vendor states that the blood supplier is labeling the products incorrectly and that the divided product must be labeled with E0938 - Apheresis FRESH FROZEN PLASMA|NaCitrate/XX/<=-18C|<200 mL or E0909 - Apheresis FRESH FROZEN PLASMA|NaCitrate/XX/<=-18C. The blood supplier is say that they are labeling the product correctly and that this is an issue with our computer system vendor. In the meantime we and the patients are stuck in the middle! So who is right? How should the products be labeled?

Years ago there was a PBS special titled "Red Gold" that was broadcast. It was a very good and basic series. I don't know what printed materials might be available that accompanied it, but here is a link. http://www.pbs.org/wnet/redgold/index.html

I read this recently on uCern (10/18/10) "Currently we do not have any clients on Millennium BBT who are using the interace to Bridge transfusion administration. We are still looking for a testing partner."

I've installed several. It is pretty easy to do...things that you need to decide are: Do you want the interpretation from the Provue to cross into Millennium or do you want to use a Millennium system validated or generated interpretation based upon the serological results? Do you want to allow results that the technologist corrects on the Provue, e.g. ? to 4+, to cross into Millennium? Tests revolving around unit numbers, for example confirmatory ABO/Rh unit testing and crossmatches have been a bit harder because of issues surrounding the unit numbers, but I belief that progress has been made on those issues.

There is not, in my opinion, a GREAT Transfusion Services software out there. Every system has it's pros and cons - I've worked with Cerner Millennium (and Classic before that), Meditech, HCLL and SoftBank. You'll need to evaluate and decide which your facility can afford and what is a good fit. Also keep in mind any history upload of previous data that you'll want to make to the new system. Some systems are In my former life I did a lot of work with Blood Bank software.

We have a "hold" order, but there is no testing performed on the sample. The sample is merely received, evaluated for specimen acceptability: labeling and hemolysis, and then held for 3 days. It is utilized primarily by outpatient cancer therapy, Emergency Department and Labor & Delivery.

Normosol-R and Plasmalyte-A were approved by the FDA for utilization in blood transfusion, but it has been a few years since I read the package inserts for either product so I'd recommend reviewing a current package insert.

Would the AABB Technical Manual, 16th Edition work? On page 448, there is a general table (Table 15-5) that states, with regard to platelets, that "All ABO groups are acceptable. Although ABO-identical platelets are preferred, components compatible with the recipient's red cells are recommended." Then on page 650 about half way down in the first column it states "Transfusion of ABO-incompatible plasma should be avoided in pediatric patients and especially in infants becaue of their small blood and plasma volumes."

Blood Banking, SBB(ASCP) http://www.ascp.org/FunctionalNavigation/certification/GetCertified/SpecialistCertification.aspx To be eligible for this examination category, an applicant must satisfy the requirements of at least one of the following routes: Route 1: Baccalaureate degree from a regionally accredited college/university including biological science, chemistry and mathematics courses AND successful completion of a CAAHEP accredited Specialist in Blood Bank Technology program within the last 5 years; or Route 2: MT/MLS(ASCP) or BB(ASCP) certification, AND a baccalaureate degree from a regionally accredited college/university, AND three years of full time acceptable clinical laboratory experience in blood banking in the U.S., Canada or a CAP/The Joint Commission/AABB accredited laboratory within the last ten years. These three years of experience must be acquired post baccalaureate degree and be under the supervision of a pathologist (certified by the American Board of Pathology) or an appropriately board certified medical scientist; or Route 3: Master’s or doctorate degree in Chemistry, Biology, Immunology, Immunohematology, Microbiology, Allied Health, Clinical Laboratory Sciences, or an appropriately related field, from a regionally accredited college/university AND three years of full time acceptable clinical laboratory experience in blood banking in the U.S., Canada or a CAP/The Joint Commission/AABB accredited laboratory within the last ten years. These three years of experience must be acquired post baccalaureate degree and be under the supervision of a pathologist (certified by the American Board of Pathology) or an appropriately board certified medical scientist; or Route 4: Doctorate degree in Chemistry, Biology, Immunology, Immunohematology, Microbiology, Allied Health, Clinical Laboratory Sciences, or an appropriately related field, from a regionally accredited college/university AND two years of post-doctoral fellowship in blood banking in the U.S. or Canada within the last ten years. Clinical Laboratory Experience To fulfill the experience requirement for the Specialist in Blood Banking examination, you must have clinical laboratory experience within the last ten years in all of the following procedures: Serologic Testing ABO and Rh Typing Antibody detection and identification Crossmatching Direct antiglobulin tests Tests for other blood group antigens Routine Problem Solving Transfusion reactions Immune hemolytic anemias Hemolytic disease of the fetus and newborn (HDFN) Rh immune globulin evaluation Quality Control Quality Assurance Laboratory Operations Donor Collection, Processing, and Testing (Proficiency may be demonstrated thorugh performance, observation or simulation) Donor selection, preparation and collection Processing or confirmatory testing Component preparation for storage and administration

From BD's website... "What are the differences between the lavender stopper BD Vacutainer® K2EDTA Tube and the pink stopper BD Vacutainer® K2EDTA Tube? The differences are the types of closures and the labeling. The lavender stopper can either be rubber or a Hemogard™ closure on a plastic tube. Product 367899, a 6 mL plastic tube, and product 367842, a 2 mL plastic tube, both have a distinct pink BD Hemogard™ closure and product 368589 has a conventional rubber pink stopper. The pink stoppered tubes have blood bank labels and are generally sent to the blood bank laboratory in the hospital. The additive is the same in both tubes." If my memory serves me correctly there was a time when only the pink top tube was FDA cleared for routine immunohematology testing, which didn't make a whole lot of sense (to me) since it is identical to the purple except for the label and the cap color. This is from the FDA website on the topic of "approved products" from BD... "BD Vacutainer Plus Serum and BD Vacutainer Plus K2EDTA Tubes may be used for routine immunohematology testing and blood donor screening. The performance characteristics of these tubes have not been established for immunohematology testing in general; therefore, users must validate the use of these tubes for their specific assay-instrument/reagent system combinations and specimen storage conditions."

Cerner Millennium is very particular about how the merges must be done to ensure that the BB History isn't wiped out. I'd recommend referring to uCern's Reference Pages (formerly known as the Cerner Millennium Support Guides (CMSG) document titled... All About PathNet Blood Bank Transfusion Patient Combines

Just a note that there is a CR (Change Request) that has been generated requesting that Cerner allow the functionality of making the Return Temperature field mandatory to be enabled or disabled via a Preferences question. CR Number: 1-3481563354 Description: With this enhancement, a preference question is provided to allow you to turn off the temperature box in Return Products or to allow a default temperature. If your facility has not already been added to this CR, I would recommend that you log an SR with Cerner and request that your facility be added to this CR. The CR has a status of postponed currently, but if enough clients request this - maybe they'll do something about it.

I recommend a one to one build. That is also Cerner's official recommendation. If you do a one to many build there will be serveral instances where users will be forced to choose which product thye have and that is fraught with the potential for wrong products to be selected. Modify Products can be particularly problematic with this. Plus if you intend to utilize the functionality to print ISBT labels directly out of Modify Products utilizing the interface to a DigiTrax printer you have to have done a one to one build. Yes, it is more work up front to do it one to one, but it will safe you a lot of headache and problems down the road.