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We presented a poster at last year's AABB on the use of EC at our hospital. We found that it decreased turnaround time, reduced re-draws for QNS, reduced blood wastage, and reduced costs for supplies. It saved us 1/2 FTE due to the near elimination of IS XM and also improved workflow and flexibility in using our workstations. Because our BB system is advanced enough to allow EC, we believe patient safety is improved by the use of electronic ID of patients, specimens, results and unit labeling. We're a pediatric hospital, and many of our patients weak or no backtype. From our perspective, EC is safer than IS crossmatch. We've not had any issues during inspections.

We're using a super out rate of 100 and a super out volume of 500 ml. When we wash a whole pheresis, the final volume is ~60-90 mls. Since the Cobe will retain at least 50 ml volume during a super out, we made the assumption that a half pheresis would have about the same final volume as a whole unit, and would just be less concentrated. Based on that assumption, we decided to only wash whole pheresis units. We were just curious to hear if anyone did it differently. We were also wondering if anyone used something other than saline to wash and/or resuspend?

Does anyone have experience washing 1/2 pheresis platelet on the COBE 2991? We have a procedure for washing a whole unit, but have not been able to find any documentation about washing smaller voumes.

We have been using a commercial document management system across the entire lab (see Lucidoc.com) for almost two years. It manages revisions, annual review, and documentation of review quite well. We've been inspected since implementing and the inspection team was impressed. The learning curve was steep for both implementing and daily use, but now both staff and management are comfortable with it. We do have a copy printed out for use only in an emergency. There is also an internal backup file available if internet access is out. The techs sometimes print out a copy to use at the time of testing, but our policy is that these copies should be discarded after using. As time goes on, more techs are simply reading them off the computer.

I would suggest you get your medical director involved in a dialog with hospital physicians if that is a possibility. We used to have a lot of problems with special needs, mostly with the needs changing back and forth, depending on which physician ordered the blood. Since we're a teaching hospital, this was especially an issue with new residents. Our medical director spent many months helping to define detailed protocols for all the different services, and then getting all the various services to sign off on them. We have neonatal, hematology, BMT, cardiac, and transplant services, so it was a huge amount of effort on his part, but the results have been fantastic. The techs now have documentation to stand behind when a physician requests something not in the protocol, and there are far fewer phone calls to physicians and path residents. This source of stress for the techs has almost disappeared. In addition, our usage and wastage of CMV neg products has dropped dramatically.

What a great answer! Having validated a system for EC, and not having a very good idea of what I was doing at the time...if I had to do it all over again, I would still use the vendor's validation guide as a starting point. I would add to it if necessary by looking at each decision point in the EC algorithm, and make sure there is a "pass" and "fail" test for each point. Make sure you test a variety of ABO/RH patients and units, different levels of antibodies, etc. Make sure you test any specific procedures/protocols your institution uses, expecially if you have made changes to the software to accomodate your facility. It might help to brainstorm with another person who is familiar with how your facility operates. I agree that if you set up a detailed plan and document everything clearly, in the end both you and the powers higher up should feel comfortable. If it's any consolation, although it is a lot of work, we love EC! It has saved us a lot of money and tech work hours, makes workload and inventory management much easier.

I agree completely with the other posters as far as transfusing antigen negative. As long as the blood is being used for replacement volume only, and not for surgery or any potential massive use, we transfuse neonates up to unit expiration with no adverse effect, and do not wash the aliquot (AS-1 units).

I use the recipes below for students/new techs. We use mostly gel for testing, and these work pretty well most of the time. The Rh, K, and M are very consistent and we get 2+ reactions or better. I don't know what kind of reactions you would get with tube testing with the Rh and K. I've had problems with the Fy, so I only use it in combination with other antibodies. Sometimes I mix it up based on what our expired panels look like. If I'm feeling particularly evil (or want to stump a student who thinks they can solve anything), I will choose several antibodies that are very difficult to identify with a particular panel. We use mostly monoclonal antisera, and I try to use expired, but since I'm only using a drop or two, I don't feel bad about using in-date reagents. I either match the antibodies to an expired panel cell to use as "patient" cells, or use some segments from a phenotyped unit if one is available. I've tried making positive DATs with reagents other than D, but haven't had much success. Elution: Anti- D, mixed field DAT 2 O Pos Segments and 2 O Neg segments Put O pos segments in 12x 75 tube. Add 1 drop of Anti-D, 2-3 drops of albumin and a little bit of saline Incubate at 37 for 30 minutes Add O neg segments [*]Gel ab screen- Anti- C Fill 12x75 tube 1/3 full of saline Add 1 drop Anti-C, 2 drops albumin [*]Gel ab screen- anti-Jka Fill 12x75 tube 1/3 full of saline Add 1 drop Anti-Jka, 2 drops albumin [*]Gel ab screen- anti-K and Anti- c Fill 12x75 tube 1/3 full of saline Add 1 drop Anti-K, 1 drop Anti-c, 2 drops albumin [*]Tube Ab screen – Anti-M Fill 12x75 tube 2/3 full of saline Add 2 drops Anti-M, 2 drops albumin [*]Gel Ab screen - Anti-Fya, Anti-E, Anti-K Fill 12x75 tube 1/3 full of saline Add 2 drops Anti-Fya, 1 drop Anti-E, 1 drop Anti-K, 3 drops albumin

We've been using AS-1 units for years (as is, no centrifugation or washing) for simple transfusions of neonates of all weights and gestation. We also use AS-1 units for cardiac surgery for neonates. We have had no problems related to the use of AS-1. Potassium is an issue with neonates who may receive large volumes of blood in surgery, so we provide blood < 10 days for surgery patients, and blood < 2-3 days for cardiac surgery. I think its imortant to realize that different facilities may have different but acceptable practices, dependent on how many neonates are transfused, available equipment, available blood supply, and how conservative the blood bank director and clinicians are. We are a large >100 nicu bed facility, and our practices are certainly different than a hospital that transfuses 1-2 babies/week. If a facility wants to know the current standard of care, it's usually best to ask several large "premier" institutions what their practice is, and then adapt to meet your needs. We do just that whenever a question arises regarding best practice for a particular procedure.

We would love to discourage directed units, but we have several services and doctors that encourage them, usually just from family members. Yes, it can give the parents a false sense of security, expecially when the units are coming from outside the immediate family. On the up side, it gives the parents a way to feel like they're helping, it means one less unit taken from the usual donor population, and perhaps the donor will be inspired to become a regular blood donor.

There is no reason that type specific directed donor blood can't be used, as long as the patient's plasma is first screened for passively acquired maternal anti-A or B at the antiglobulin phase. The unit should also be negative for any other antigens to which the baby has passive antibodies. As long as the directed unit meets all donor requirements, the unit is no different from a random unit pulled off the shelf. If the unit is from an immediate family member, it should be irradiated to prevent graft vs. host.

We provide leukocyte reduced (not CMV neg) AS-1 irradiated blood products for all simple transfusions of neonates. We set them up on fresh (less than 7 days) units and continue to provide that unit if needed until expiration. We give group specific blood, but we transfuse a large number of neonates, and are able to efficiently use all the unit. As I understand it, the only reason to use O blood is to share the unit so as to limit wastage. We either wash or pack to remove Adsol for neo exchanges.