goodchild

Thank you for slightly improving a miserable Monday morning. Bahahahahahahahaha.

This is something the vendors certainly glossed over while doing their demo. I'm not certain I fully understand.

Out of curiosity, how are laboratory investigations of transfusion reactions handled when the patient's pretransfusion sample is at a different location?

We wrote in our policy that we don't expect 100% concordance, cited several publications regarding the differences between the methods, and made a note that the blood bank supervisor and medical director will both review the results to determine the significance of any observed discrepancy.

We actually do what you do. A checklist of things that people are required to check. We have a blurb that if something is updated, the package inserts binder is updated, the old copy retired, and then we determine any need to make people specifically aware if there are substantial changes. If something is unacceptable it goes on quarantine log for supervisor to follow up on, etc. My critical materials log doesn't have the 'in service' date because that would be in our QC manual.

Chang, C., Brown, M., Davies, L., Pointon, L., Brown, R. and Barker, D. (2014), Evaluation of Erytra® fully automated analyser for Routine Use in Transfusion Laboratory. Transfusion Medicine, 24: 33–38. doi: 10.1111/tme.12073 Taylor, J., Hyare, J., Stelfox, P., Williams, M., Lees, R. and Maley, M. (2011), Multi-centre evaluation of pre-transfusional routine tests using 8-column format gel cards (DG Gel®). Transfusion Medicine, 21: 90–98. doi: 10.1111/j.1365-3148.2010.01054.x Roback, J. D., Barclay, S., Moulds, J. M. and Denomme, G. A. (2015), A multicenter study on the performance of a fully automated, walk-away high-throughput analyzer for pretransfusion testing in the US population. Transfusion, 55: 1522–1528. doi: 10.1111/trf.13053 Not exactly what you're looking for but these are out there.

(I don't claim to be a HIPAA interpretation guru) but to me that sounds appropriate. As a blood banker, having access to clinical laboratory and especially blood bank information is valuable in establishing a history for a patient and isn't a breach of HIPAA if used for that purpose under the continuity of care. We have access to our state's health information exchange, which is essentially a web-based database of all hospital encounter/medical record/laboratory documentation in the state for the past 4 years. We use it to determine history on antibody patients and it has been invaluable. The only thing that seems odd is that it doesn't understand when a type and screen is done at one place or the other.

@Kellimq As a sincere appreciator of process control and flowcharts, whoever designed that document is a genius and has my praise.

My answer would be to follow manufacturer's instructions.

CAP TRM.42850: Alarm Sensors To Trigger Action Needed Alarms are adjusted to be triggered before the temperature falls outside the 1-6° C acceptable temperature range for refrigerators, or outside the acceptable range for freezers and platelet incubators. NOTE: Refrigerators, freezers and platelet incubators must have alarm systems that provide opportunity to take action before the temperature of blood or components is outside of acceptable ranges. Red cell units stored at temperatures higher than 6° C may be subject to accelerated bacterial growth. Temperatures below the freezing point may induce hemolysis. Freezers need not be operated at their lowest possible temperature, since some plastic plasma containers held at temperatures lower than -25° C may exhibit increased breakage rates upon handling. Evidence of Compliance: ✓ Records of trigger temperatures during alarm checks AND ✓ Records of corrective action, when appropriate The CAP perspective when I last discussed this topic with them at great length: Your alarm activation documentation must show the temperature at which the alarm activated, to prove that they are functioning within the constraints that this checklist item describes. We have an electronic continuous temperature monitoring setup here, so we can load up the alarm activation event and print a nice little report for every probe in every device to satisfy the inspectors. Perhaps you could create a spreadsheet with all the devices/probes, their temperature ranges, their alarm setpoints, and the temp at which the alarm sounded. A site that I inspected earlier this year did exactly this.

Dansket, as long as you have documentation that describes the specific range for each storage device, what the alarm set points are, the temperature at which the alarm activated, and that the temperature didn't violate any of these constraints then I completely agree with your system. Alarm activations are annoying enough, why do inspectors feel the need to make them more onerous?

Malcolm, it seems Europe gets all the stuff that I want. If only I had the ability to emigrate.

@Dansket The theoretical cost savings comes from the use of A/B/D/Ctrl/A/B/D/Ctrl cards for front typing and neutralx8 cards for reverse to do your blood types. With all of the discussion of Rh discrepancies, I was secretly hoping for a blood type card that included two different anti-D reagents but they don't have anything like that right now.

We actually had a case last year that would strongly support continued performance of antibody identification in the face of a pannagluttinin/antibody to public antigen, even when providing common RBC antigen-matched RBCs. One day when we have free time (bahahahahahahahahaahaha) we plan to write it up.

You mean the service rack is full?

We only get as specific as to indicate something is washed and/or something is irradiated.

I try to turn unique scenarios into 'case studies' for the group..

@StevenB I'll message you some details of our own internal study regarding 'informative eluates.'

I would review some of these references with your pathologist. It's definitely not an exhaustive list. Judd, W. J., Butch, S. H., Oberman, H. A., Steiner, E. A. and Bauer, R. C. (1980), The Evaluation of a Positive Direct Antiglobulin Test in Pretransfusion Testing. Transfusion, 20: 17–23. doi: 10.1046/j.1537-2995.1980.20180125036.x Judd, W. J., Barnes, B. A., Steiner, E. A., Oberman, H. A., Averill, D. B. and Butch, S. H. (1986), The evaluation of a positive direct antiglobulin test (autocontrol) in pretransfusion testing revisited. Transfusion, 26: 220–224. doi: 10.1046/j.1537-2995.1986.26386209372.x Stec, N., Shirey, R. S., Smith, B., Kickler, T. S. and Ness, P. M. (1986), The efficacy of performing red cell elution studies in the pretransfusion testing of patients with positive direct antiglobulin tests. Transfusion, 26: 225–226. doi: 10.1046/j.1537-2995.1986.26386209373.x Domen R.E. and Grattan J. (1986). Efficacy of performing red-cell antibody elutions in patients with a positive direct antiglobulin test, Vox Sang, 51:324-326. Johnson, M.F.M. and Belota, M.K. (1988). Determination of need for elution studies for positive direct antiglobulin tests in pretransfusion testing, Am J Clin Pathol, 90(1):58-62. doi: 10.1093/ajcp/90.1.58 Perkins, J.T., Arruza, M., Fong, K., Sosler, S.D., and Saporito, C. (1990). The relative utility of the autologous control and the antiglobulin test phase of the crossmatch, Transfusion, 30: 503-507. doi: 10.1046/j.1537-2995.1990.30690333479.x Richa, E., Benidt, G., Tauscher, C., Stowers, R., Bryant, S., and Stubbs, J. (2007). Eluate testing following microscopically positive direct antiglobulin tests with anti-IgG, Ann Clin Lab Sci, 37(2):167-169. Yazer, M. H. and Triulzi, D. J. (2009), The role of the elution in antibody investigations. Transfusion, 49: 2395–2399. doi: 10.1111/j.1537-2995.2009.02304.x

Hi everyone, Doing an informal survey for anyone willing to contribute. If you're willing to respond but not in the thread itself, please feel free to message me. When do you perform an elution? (e.g. all positive DATs, all positive DATS within 3 months of transfusion, IgG positive only) What method is utilized for the elution? What method is utilized for testing the eluate? How is the eluate tested? (e.g. screening cells, full panel, specially selected cells) Feel free to mention any special notes/criteria for which I may not have though to ask. Thanks in advance to all participants!

I hope someone comes up with them soon. I would be much happier with gel DATs to get rid of a little subjectivity.

I lost my button just thinking about Lab Week..

You need to perform daily QC on the blood bank saline used to create donor cell suspensions.

We've never done correlations either.

I'm not familiar with Magic, we have C/S. Magic doesn't have BBK History files? WHAT?!