goodchild

We include a field under the Type and Screen result entry field for Previous History Check: Previous History/No Previous History. This field is responded to immediately upon receipt for patient's with no history. On a No Previous History result, a chargeless Retype test is reflex-ordered under a new requisition for the patient and loads on the phlebotomy team's draw list (or depending on the patient's location we'll notify the patient's nurse for collection). We don't reflex Retypes on anything but Type and Screens. We will perform and result a second front type on all blood types that are performed when a Retype isn't completed, one that stays on the same requisition, as a quality check/confirmation (e.g. cord bloods, ED vaginal bleed Rh type checks, patient's who depart ED without Retype collection, etc.)

It stands to reason that if your medical director determined that this would be the route to go and it became your standard protocol for antibody identification testing that you would charge for it.

We have an interpretation of "anti-Bg"

American Academy of Pediatrics: "Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation" http://pediatrics.aappublications.org/content/pediatrics/114/1/297.full.pdf

We provide Rh and K antigen matched, Hgb S-neg RBCs for every sickle cell patient. We also conduct a quick history sweep with area hospitals/reference labs, covering at least as far back as the last encounter we had with the patient, or as far back as reasonable/possible for new patients. We're lucky that we have access to our state's health information exchange, so we can log onto a website and see every hospital/ref lab encounter since 2012 and readily determine who to call.

Thank you for this question. We're going to QC the potentiators every other day without requiring day of use QC. Rewriting our reagent QC plan now. Curious what others do.

Considering that in the grand scheme of things, blood inventory management is a community responsibility, using group O blood for this patient would be seen by the vast majority of blood bankers as harmful/wasteful.

I have to believe that this is an elaborate trolling event.

I can tell you that we never allow one individual to pick up products for more than one patient at a time. In my understanding, that's a blood bank procedure/process/policy and would fall under the discretion of your medical director (and you as blood bank supervisor).

I have to admit I'm confused Ronald. Why the focus on anti-A1? With the O or B blood that you suggest, would you also be prophylactically matching Rh, Kell, Duffy, Kidd, and MNS blood group system antigens?

Just out of curiosity, are you implying that at your previous establishment K+k- panel cells were required for rule out?

It seems like we're always an outlier. We look for two negative K+k+ panel cells.

Interesting, thank you for sharing.

We're going to trial some of their reagents, a manual workstation, and a card reader in the near-ish future. I saw a demo of the Erytra and was very impressed, until I looked at some of the images the Erytra took of the gel card reactions and interpreted as negative - a few of them looked like what the ProVue would call ? or 1+ but were still being interpreted as negative. When I asked the technologist, I didn't get a very satisfying response. Has anyone else had a chance to see an Erytra in action yet and seen this?

@JustaKIDD They do have an IS-equivalent via neutral cards. It would probably only make sense to run IS XMs on the Erytra if you were going to wrap it into a profile test with the IAT-XM.

That's a very perceptive question from a student!

I recall a lot of discussion on these boards about the relevance and history of the 4 hour timeframe.

That's definitely how that line could be interpreted. The other two lines could be argued to point to a four hour timeframe from start.

Make sure you read the entire package insert. Ours states that the specimen should be from a known Rh-negative mother, collected as soon as possible after the first hour post-delivery of all products of conception, and the baby is Rh-positive.

Circular of information states verbatim under the "Instructions for Use" section: "Transfusion should be started before component expiration and completed within 4 hours." Later, under red blood cell administration, it states: "It is undesirable for components that contain red cells to remain at room temperature longer than 4 hours. If the anticipated infusion rate must be so slow that the entire unit cannot be infused within 4 hours, it is appropriate to order smaller aliquots for transfusion." We go with 4 hours from start time.

Same minus the printing. Everything is backed up automatically.

How is it tabulated to the patient's account? e.g. does the supervisor review all antibody workups and enter charge codes?

Anyone else? Is anyone out there using CPT 86885?

I was having that same problem on my grossly outdated version of IE, so I switched to Chrome (which work has only recently permitted as an alternate browser).

Technical Manual, 18th edition, Chapter 17, DAT/Immune Hemolysis, page 428. Test an eluate prepared from the DAT-positive red cells with reagent red cells to determine whether the coating protein has red cell antibody specificity. When the only coating protein is complement, the eluate is likely to be nonreactive. However, an eluate from the patient's red cells coated only with complement should be tested if there is clinical evidence of antibody-mediated hemolysis, for example, after transfusion. The eluate preparation can concentrate small amounts of IgG that may not be detectable in routine testing of the patient's plasma.