goodchild

It's interesting that you posted this because the supervisor and I reviewed our Meditech Antibody and Antigen dictionaries just recently. It hadn't been done in many years and whoever set it up previously configured antigen warnings and IAT XM for every antibody, so review/revision was a long time coming!
One difference from the discussion here that we decided upon was to retain the requirement of IAT XM for antibody of undetermined specificity (INC).

It's interesting that you posted this because the supervisor and I reviewed our Meditech Antibody and Antigen dictionaries just recently. It hadn't been done in many years and whoever set it up previously configured antigen warnings and IAT XM for every antibody, so review/revision was a long time coming!
One difference from the discussion here that we decided upon was to retain the requirement of IAT XM for antibody of undetermined specificity (INC).

It's interesting that you posted this because the supervisor and I reviewed our Meditech Antibody and Antigen dictionaries just recently. It hadn't been done in many years and whoever set it up previously configured antigen warnings and IAT XM for every antibody, so review/revision was a long time coming!
One difference from the discussion here that we decided upon was to retain the requirement of IAT XM for antibody of undetermined specificity (INC).

So, the easy questions first eh Mari?????!!!!!!!!!!!!!
Personally, I think the IT guy gave you a poisoned chalice.  The reason I say this is because we can all list antibodies that are not generally considered to be clinically significant, and then, all of a sudden, one comes along amongst these specificities that has not read the appropriate text books and goes ahead and causes a clinically significant reaction.  Then what happens is that the person who said "anti-X" is not clinically significant, and this single example of anti-X turns out to be clinically significant, and you have to defend this in court.
The real problem these days is that the technologies available to us are now much more sensitive than when I started (when cross-matches were recorded on a stone slab with a hammer and chisel) and many antibodies that were not clinically significant (because we just didn't detect them with the technologies available at the time) are now readily detectable - BUT, they are not necessarily detectable at strictly 37oC, as , for example, many examples of anti-M are now detected by "IAT", even though they do not really react (in real terms) at 37oC.  The real problem comes when, for example, an anti-M genuinely DOES react at 37oC, and it is treated as clinically insignificant, electronic issue is used, and one or more of the units is M+ and the patient has a severe reaction - who answers in court?
The worrying thing is that there have been papers published over the last few years quoting an anti-Leb as causing a transfusion reaction, and an anti-P1 causing a transfusion reaction (a certain Garratty G being a co-author on this one).
I would say, therefore, that the best thing to do is to read through the relevant parts of The Blood Group Antigen FactsBook, Human Blood Groups and Mollison's Blood Transfusion in Clinical Medicine (latest editions in each case), and use their experience, rather than your own (no insult intended) as the courts would probably take the authors as "experts" should you come across any of these clinically significant "outliers".
I wish you the very best of luck!

After that laundry list what's left to love?  I do like the user interface. . .

This is slightly off topic, but I wondered if anyone does a gel crossmatch for a patient with anti-D or just selects an Rh negative unit.  We also have a separate antibody for Rhogam (DRHIG) and do IS XM when the screen is negative.  I am not sure if I want to make an exception for my techs and have them not do a gel crossmatch.  Sometimes the less they have to think about exceptions the better!

Well, that's me finished.  I am officially retired from work - but not from this wonderful site!

Perhaps check with your LIS analyst to see if they can create a separate antibody in the dictionary that would represent RhIg and set the clinical significance of the antibody to 'no.'

Yes, I agree that, in this particular case, you could have missed the immune anti-D gagpinks, BUT, as I have said several times throughout this thread, this is a very unusual case.  I am no statistician, and so I would not like to say that it is 1 in a million or something like that, but I will say that it is 1 in an awful lot and, because of the rarity of such a case, I would also say that, if a cost/benefit study was to be performed, to see if there should be any changes to the BCSH or RCOG Guidelines with regard to when to test the women's plasma during pregnancy, the answer would be that the Guidelines would not change, as so few cases would be detected, compared with the cost of being able to detect such cases.  So, yes, in this case if you had not noticed the strength of reaction, the immune anti-D may not have been detected, and it may have resulted in a baby affected by the anti-D, but one cannot change general Guidelines using such unusual cases.

You can never charge two HCPCs codes for a single transfusion. You also can't individually charge testing/processing CPT codes if there's a bundled HCPCs code that describes it best.

What you're both saying makes sense. I've tried it twice in test, though, issuing a unit after 72 hours but before 2359 on that 3rd day after phlebotomy, but I'm not getting an override warning, and nothing is showing up on the override report. It just let me sail through the issue string. The crossmatch was on my Old Crossmatch Report indicating the XM was expiring at 2359. The Specimen Expire hours are set for a minimum of 71, maximum of 72.
 
Our nurses are not using TAR (yet).
 
I went to the nice, big, comprehensive systems procedure manual provided by Meditech to check exactly how this works, but I must have misplaced it. Can't find it anywhere.

Heard from the FDA.  Variance is no longer required.  This is an unlicensed product and may not be shipped across state lines.
 

I didn't think you needed a variance, it's an unlicensed product. I'll have to research/think.

I may be opening a can of worms but I would not have done any validation and left it up to biomed to do their function and temp checks according to manufacturer's specs.   Do you validate IV pumps or rapid infusers?  

One day I was training a new tech at the end of the day. They called a reaction & I was going through the process saying how much easier it is now than when I started Blood Banking & the work ups didn't take much time. Positive post DAT. Negative elate. I decided to test some low incidence positive cells & there was an anti-Diego a in eluate (and in pretransfusion plasma when we tested that with those cells).  I just told myself to "never say never" in Blood Banking. 

We have a separate test called a P Neg (pretesting negative) that gets ordered day of surgery.  Assuming the patient has not been pregnant or transfused (answers to those questions are part of the p neg test) and the pretesting screen was negative, all that is performed is an ABO/Rh.  However it was built (not by me) Meditech accepts that result as the screen and allows us to issue units to that P neg specimen.  We do pre testing up to 30 days out.

There's no requirement to measure the temperature when you receive blood products from the supplier, only to confirm that the products were shipped appropriately.

Nope. It is consider manufacturing not pooling. When you are pooling cryo, final product is pooled cryo.
When you reconstitute final product is whole blood and it is consider manufacturing. Same thing with volume reduction of platelet. .....you need FDA registration.
 

There's no requirement to measure the temperature when you receive blood products from the supplier, only to confirm that the products were shipped appropriately.

If you read the manufacturer's instructions for Ortho Gel it says: "In some low ionic strength test systems, certain antibodies, such as anti-E and anti-K, have been reported to be nonreactive."

This was actually studied.
Schmidt, A.E., Kirkley, S., Patel, N., Masel, D., Bowen, R., Blumberg, N., & Refaai, M.A. (2015). An alternative method to dithiothreitol treatment for antibody screening in patients receiving daratumumab. Transfusion, 55(9), 2292-3. doi: 10.1111/trf.13174

This was actually studied.
Schmidt, A.E., Kirkley, S., Patel, N., Masel, D., Bowen, R., Blumberg, N., & Refaai, M.A. (2015). An alternative method to dithiothreitol treatment for antibody screening in patients receiving daratumumab. Transfusion, 55(9), 2292-3. doi: 10.1111/trf.13174

This was actually studied.
Schmidt, A.E., Kirkley, S., Patel, N., Masel, D., Bowen, R., Blumberg, N., & Refaai, M.A. (2015). An alternative method to dithiothreitol treatment for antibody screening in patients receiving daratumumab. Transfusion, 55(9), 2292-3. doi: 10.1111/trf.13174

I just joined the site, and have some questions about competency assessments.  We have staff that rotate between two different campuses of the same hospital, but the labs have different CLIA numbers.  So we were recently informed that we have to demonstrate competency at each site where our staff works.  (Even though we use the same procedures, follow the same standard work, and have standardized things completely.)  So I am trying to put this into practice without overwhelming our staff, but I still want to make sure we are doing a thorough check.  We have a high percentage of new staff right now, so I don't want to half-a$$ it.
Question 1:  Competency must be assessed for every "test system," but what are the Blood Bank test systems you assess?  Do we need to assess competency for every method of testing we use every year?  Or would I be able to assess IAT as a test system and rotate yearly on what method we use?  I cannot seem to find any Blood Bank-specific listing of test systems that require annual competencies!  It seems pretty clear for other areas, but I am getting a bit stressed out trying to make sure we are fulfilling the requirements for CAP/AABB.  And I also don't want to overwhelm our staff with 17 yearly competencies.  
In my lab, we perform the following tests:
ABO/Rh - automated gel and tube testing Antibody screens - automated gel, manual gel, and tube testing DATs - manual gel and tube testing Antibody titration - manual gel and tube testing Antibody identification Antigen typing Elutions Fetal bleed screens Question 2:  How do you handle items that you want to do a competency assessment on that are not tests?  For example, we do quite a bit of component preparation, so we generally try to do an annual competency assessment and direct observation of our staff splitting a platelet into a pediatric dose.  I am familiar with the 6 elements of competency assessment (show below), but I struggle with how to apply these to processes.
"The following six (6) procedures are the minimal regulatory requirements for assessment of competency for all personnel performing laboratory testing:
Direct observations of routine patient test performance, including patient preparation, if applicable, specimen handling, processing and testing; Monitoring the recording and reporting of test results; Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records; Direct observations of performance of instrument maintenance and function checks; Assessment of test performance through testing previously analyzed specimens, internal blind testing samples or external proficiency testing samples; and Assessment of problem solving skills."  
Thank you in advance!  
Susan

Greetings Community!  I would like to talk to anyone who has experience operating a blood bank in the pediatric setting.
The Blood Bank that serves my Pediatric hospital is located in the building next door, and therefore the staff at the Pediatric hospital feel that they "do not have a blood bank" (even though they are all connected by pneumatic tube and you can walk out of the door of one and into the other within several strides).  Therefore, there are several refrigerators throughout the hospital containing a unit or two of O- Emergency RBCs that they can grab and transfuse as uncrossmatched (filling out the appropriate paperwork and sending with samples to the Blood Bank).  They are located in the ER, OR, PICU, and NICU.
For anyone who stores RBCs like this for pediatric use, how old are the RBCs in the refrigerator?  Do you irradiate them? 
For anyone who does NOT store RBCs like this, how did you convince everyone that you could deliver uncrossmatched RBCs quickly enough that they should just order them from the Blood Bank?  I have suggested that they can just call and we can get them what they need, but was met with the argument that "when we need them, we need them now."
Thanks in advance!
Heather