goodchild

We limit the waiver of repeated ABIDs to same admission only.

Thanks Malcolm. I've wanted to initiate something like this for years now.

Wow and I thought we had it bad....

Rabble rabble rabble ! We determined our procedure based on our own experience and a creative interpretation/application of AABB 5.14.3 in general. If you read 5.14.3.2 it says: "If the patient has been transfused in the preceding 3 months with blood or a blood component containing allogeneic red cells, if the patient has been pregnant within the preceding 3 months, or if the history is uncertain or unavailable, a sample shall be obtained from the patient within 3 days of the scheduled transfusion. Day 0 is the day of draw." We complete our requirements for standard 5.14.3.3, with the initial specimen: "In patients with previously identified clinically significant antibodies, methods of testing shall be those that identify additional clinically significant antibodies."

We don't do a postnatal blood type either.

Nope.

We draw and perform a Type and Screen on all mothers coming in for delivery/pregnancy-related-observation.

What does the 'instructions for use' indicate for your infusion sets?

As long as we've been short-staffed, I think I would laugh hysterically if someone expected our blood bank to start delivering blood products.

I would recommend for coolers. We set up batches in the blood bank in the cooler before they arrive and hand it off when they show up, then prepare the next, so on. Frequently we'll get coolers back with products in them. We also affix Hemotemp stickers.

We also have a policy regarding the 'development of a quality document,' i.e. policy/procedure. We don't have a corporate template (yet?) for which I am grateful. We also run into the font size issue but we've met in the middleground at 12pt font. On the subject of fonts, did you know there's an entire school of thought based on them? I had never heard of it until a childhood friend who's going back to school for design enlightened me, typology. Kind of fascinating in a nerdy way that something so taken for granted has a rich history and researched/intentionally-crafted design.

Can someone point me towards the regulation that says it must be transfused within four hours from leaving the blood bank? The circular of information only indicates "transfusion must complete within 4 hours."

Scott our procedure explicitly describes these scenarios. A: If it's possible to confirm the patient hasn't been transfused or pregnant in the last three months, the screen results are consistent, and it's within the same hospital admission - we can forgoe a repeated antibody identification. B: Selected cell rule outs to detect additional clinically significant antibodies.

I get the impression we're an outlier on this detail. We start our 4 hour timer from the time the bag is spiked, not from time of issue. Oh but yeah our policy says it should be started as soon as possible and to coordinate return to the blood bank if it will be a >20 minute delay.

Interesting. Right now for us it's in a separate box sandwiched between the patient demographics and the specimen information.

You have me concerned because we're scheduled for this upgrade in the coming months and we also use the BBK History comments to convey a lot of information. When you describe the placement of information on your specimen inquiry though, I'm confused and would be very curious to see it.

I think I'm following now and we see this occasionally here. e.g. someone is being proactive on a patient with a history of anti-E and runs the 2 or 3 additional selected rule out cells + AC at the same time or at least prior to the completion of the antibody screen and you end up with unexpected reactions in the panel and a negative screen. Those situations lead to additional testing for us. While we do transfuse patients without history of antibodies based on a negative screen, if we have a known history of antibody/transfusion, and get an unexpected reaction we would want to know what we're seeing. Especially since our AB ID testing is manual gel and our Type and Screens are on the ProVue and Ortho only promises 98% concordance with a 95% confidence level between the two. Now, if the positive panel cell was known to be positive for a patient's low incidence antibody and we had sufficient rule outs from the other cells tested, that's a completely different story.

Yeah, unfortunately you have to follow the manufacturer's instructions. Our manufacturer also has quarterly checks built into its schedule so we're obligated to perform them.

Isn't it based on the UMich study? 1+ tubes/2+ gel were recommended for interpretation as Rh-neg/further investigation.

Practice, confidence, and make sure you're going in at a low angle. I haven't done any collections since 2009 but prior to that it was countless hundreds (maybe thousands?) of donor units. That's the best I can pull from memory.

I've read that three times now and I'm still not sure what you're asking. Bleh and it's not even Monday...

I actually have this on my list of things to discuss with CAP because it's somewhat ambiguous. The way I read it leads me to believe if you don't have a previous record (and no second specimen drawn to confirm type) then a disclaimer should be released with the result. Performing a check but having no previous record to check doesn't seem like it exempts you from the purpose they describe in the note: "to detect sample/patient identification errors ...; this might lead to a missed opportunity to provide prophylaxis against or appropriate treatment for perinatal alloimmunization." Seems like this is aimed at places that do outpatient/clinic prenatal testing. Granted, I haven't implemented anything like this at my institution (yet?).

Perhaps this is kind of cheating but we go with our primary panel = 11 cells. If reference lab charges 20 selected cells we calculate two panels.

In CAP Transfusion Medicine Checklist, under Perinatal Testing: TRM.40820 Historical Record Check Phase II There is a written procedure to ensure that laboratory records for ABO/Rh testing are searched for each pregnant patient for at least the preceding 12 months. NOTE: The purpose of this comparison is to detect sample/patient identification errors or other errors that might lead to the attribution of an incorrect blood type or antibody screen result to a pregnant patient; this might result in a missed opportunity to provide prophylaxis against or appropriate treatment for perinatal alloimmunization. If the laboratory performing the testing does not maintain records that would allow this check to be performed, the testing shall be reported with a disclaimer alerting the ordering physician that the check has not been performed and that verifications of the sample's identity and the test results are strongly recommended. Evidence of Compliance: ✓ Written procedure for checking ABO/Rh and antibody screening results with historical results AND ✓ Records of historical checks