DOGLOVER

Hi, I would suggest you start by reviewing procedure manuals and while reviewing make sure that you match them up with AABB and CAP checklists to make sure you are meeting all requirements. You can write on each checklist item where it is documented . This will help immensely when it comes time for inspection. You don't want to have to review everything at once so set up some kind of schedulte (monthly/ quarterly/whatever) for doing these reviews. As long as you have copies of any variances/occurences along with any associated FDA reports the FDA son't be too bad. I'm assuming you don't have a donor center. Check with your HR and education departments to see if any classes are offered for manager development/training. This is important because most people in healthcare are poromoted because of technical or clinical expertise, not because they know how to manage people. People are the tough part. its way more then just writing a work schedule. Definitely use this forum. its great. In my area our local blood supplier sponsors a quarterly luncheon meeting (coincides with AABB audio conference) where we get to know each other, discuss local issues and bounce ideas of each other. We are all very comfortable with e-mailing or calling each other with questions ranging from history on hospital-hopping patients to new equipment, reagents, procedures, etc. Good luck in your new position and let us know how you are doing.

Thank-you very much. By the way, I see you are in NH, beautiful state that I grew up in. Maybe I can come back and retire there.

Does anyone have a procedure for therapeutic phlebotomy that they are willing to share. We are in the process of bringing this procedure in house for inpatients rather than having our blood center team do them. I have done them in another time and place (over 12 years ago) and do not have a procedure. The one in the technical manual is written for actual donors. It also does not specify how high the pressure cuff should be inflated to. Thanks to anyone who can help.

We test cord bloods from group O mom's. Trouble is that if a positive DAT is found, then (at least at one of the smaller facilities in our system) then they want an elution which of course doesn't tell us anything we didn't already know. Good luck in getting rid of this testing. Wish I could.

Wondering what people are doing when it is necessary to give Rh pos platelets to an Rh negative female of child bearing potential. We give RHIG and consider it good for 21 days or 7 pheresis platelets. After that we do an antibody screen, if anti-D is detectable we consider the patient to still be covered. When the screen becomes negative or after 90 days another dose of RHIG would be given if more Rh pos platelets were needed. Thanks for your input.

In 35 years of Blood Bank have seen 1 Bombay and it was not found by running a group O cell with backtype but found on antibody screen. I sure don't want to know about any cold agglutinins that are hanging around so do not run group O cells when typing.

In over 30 years of Blood Banking I have not had a problem with the protocol of doing an IS xm when the 3 cell screen is neg. The last 12 years have been where there are large sickle cell populations. The sicklers that I have seen with antibodies to low-freqs always have had multiple other antibodies so one would be doing a full xm anyway. I remember one lady (106 years old) many years ago with anti-Kpa and no other antibodies (not a sickler) but thats about it. So an electronic crossmatch would fit the same critieria.

Does anyone have any info on auto-antibody formation in sickle cell patients. We see it happen frequently but haven't been able to find references on on how it happens or what to do about it? I have heard that it is due to "hidden" antigens being exposed when cells sickle but have not been able to find it in writing. Thanks and I hope everyone had a Merry Christmas.

We just do a confirmatory forward type at no charge. Blood Bank initiates the order when we find we have no historical type (or if the patient is group O we don't require it). If there is another sample in the lab from a different time we can use that otherwise we tell the nursing unit or OR that a confirmation must be drawn. Lots of complaints at first but now everyone is pretty used to it even the pediatric hospital. Nursing does the majority of draws at our facility.

We receive mostly the 24 hour product from our supplier and use thme interchangeably. Most of the time the product is not being given for any particular factor deficiency anyway. If I knew it was for one of our kids with FV deficiency I would probably choose an FFP, just because...........

Had a similar situation a couple of weeks ago and it turned it to be an HTLA antibody.

His father was an embryologist.

I had an order for a super DAT once. Sent it out and if I recall correctly what they did was a gel DAT.

We also were having problems. Switched back to Ortho anti-D.

We would call it inconclusvie antibody and issued crossmatch compatible (by gel or PEG) units. We seem to get these on a fairly frequent basis.

We have 3 smaller hospitals in our system which transfer babies to our NICU. "once in a blue moon" a baby needs to be transfused while in the ambulance or helicopter and we just tell them to use a whole unit and the neonatal transport team can use what they need out of it.

We use the 3 day rule (from date of sample draw) and just override the 72 hour thing in Cerner. Date of draw is day 0. If you go for 48 hours after crossmatch and did the crossmatch on day 3, you are now up to 5 days which of course is fine if you are sure the patient has not been transfused in the last 3 months. It would be a huge pain, here to ascertain that this has not occurred and to document.

I like the current name. Please don't change unless we have to.

We assign one unit per baby. Twins, etc do no share a unit unless the family makes a big issue out of it and convinces the medical director to make an exception. They all get group O Rh matched, irradiated, leuko-reduced units with ADSOL. The K+ has not been a problem. If a kid weighing less than 5 kg is having open heart surgery they get washed units. Between 5 and 10 kg we use additive free in the cardiac OR.

We order a TRXN in Cerner Classic. We have a form built for this test and go into PRE where we fill in our results and then put in a template for whatever kind of reaction it was. The pathologist then looks at it and if he/she is happy with everything verifies it. We just did the last upgrade for Classic that will exist so sometime before it sunsets it will be on to Milenium. I would be interested to hear how folks are liking Millenium.

We use the Charter Med syringe system which has a 150 micron filter. We make the syring in Blood Bank and they don't have to filter again in the NICU. We have about 50 NICU beds and this system works well for us. If a larger amount is needed we put in a pedi-bag and the floor uses a Charter Med transfer set which also has a 150 micron filter.

I don't know of any regs regarding this. We don't unless you happen to have gloves on. I usually take them off to issue because they may be dirty and the adhesive on the part of the tag that becomes a unit label sticks to the gloves. Never had an inspector (FDA,AABB, CAPor state) in either Mass or Florida say anything.

We keep a supply of ADSOL free units on hand for out open heart and ECMO babies. Our blood supplier draws some that way for us because we are the major children's facility in the area.

I agree, we always use antigen negative units in this situation. Our policy is that all neonates get the same unit until expiration or until gone, whichever comes first. Also all our neonates receive irradiated products because we were not always getting information on tiny infants less thatn 1 kg so we decided to just give them all irradiated. The only time we wash basically is for open heart surgery on a kid under 5 kg. Between 5 and 10 kg we givce additive free for open heart. Regular NICU babies get ADSOL blood most of the time.

I think it is preferable to use tubes with PEG or LISS if these are compatible rather than fooling around with absorptions. This is, as others have noted, a pretty common occurrance esp in the sickle cell population.