Barbarakym

We use EDTA and do not separate. We started not separating after a series of errors on GY where cells/plasma were mixed up and not initially caught. We have not had any negative issues with not separating.

This is our policy. If machine gets 2+ or less positive D, we do Tube testing and take that value. If it is a new patient, 2 techs do the testing.

First: AABB standards call to be sure you are not missing a potential fetal maternal bleed which can show up as weak D in the mom. From how I read the standard any weak D is suspect. Thus we only do moms at IS but baby of neg mom gets done to AHG (as required). Mom will get rhogam if baby is positive at coombs but otherwise baby is treated as the RH Neg they are by IS testing. In my former institution (300 beds, level 4 neonatal unit)... in the 90's it was vogue to call Weak D positive as Rh Positive. We gave blood and platlets accordingly. During my time there I am AWARE of 6 people (may be more) who were Rh Neg by IS and Pos by Coombs that we gave an allo Anti D to by giving them Rh positive products. Due to risk we STOPPED the process in early 2000's. To me there is more risk in calling a negative person positive than the other way around. Likewise, getting rhogam unnecessarily (genetically) is the lessor risk than sensitizing an Rh negative young mother to ALLO Anti-D. I believe from the wording of the AABB since 2005 (pamphlet by AABB on moms/babies) they believe so too.

I actually use my Tech manual to also explain the darn rules from the standards. Some are just not written clearly, IMO. In the tech manual a regulation is often referred to as MUST do this.... Whereas an option (idea) is referred to as SHOULD do or MAY do. These terms are defined in the standards but as of the date of the Tech manual printing are usually pretty accurately described this way also in the tech manual. I use my Tech manual constantly and then refer to the standards to be sure policy I wrote is addressed. Usually they agree. When REALLY in doubt I pose question here.... did I say I LOVE THIS SITE...... So many people with so many other takes on things.... Really has improved my procedure writing.

Another good basic point. Look for a horse in a herd of horses before you look for a zebra. Though finding zebras are much more interesting, I agree.

Only if you are making a new product. To pool a 2 bag plt or divide a unit.. I don't think you are FDA inspection material. To WASH products, to combine products...to make a new product (10 cryo into 1 bag)... then yes. Any inspectors out there who can clarify?

I don't consider tube testing to be less quality as far as typing is concerned. It is faster and cheaper and all same doublechecks and pt ID is involved. Machines are not always right either. Just saying.

If it comes back to the BB we discard. If they call and ask I tell them they have 4 hours to infuse. If not infused by that time to return the unit to BB (So we can change our transfusion record... pt not got unit) or if started, discard the balance of the unit at that time. BUT if it comes back to blood bank and is warmer than 10 degrees.... its history. They will have to order a new unit if they want it. I don't reissue something that has been out of temp.

John. I do not have my standards book handy BUT even though the technical manual was quoted that is consistent to the actual standards. 4 hours is not a recommendation but a requirement.

This is the regulation. Not room temp open system. If unit issued from Blood bank at 1PM, then transfusion needs to be concluded no later than 5PM. HOWEVEDR, cooler situation is different because the COOLER is now considered storage (1-6 degrees C). So issuing from the cooler (from whatever dept) is considered the same as when you take it out of refrigerator... Spike time for practicle purposes... Take out of cooler, spike, ok for 4 hours. Just write a note in training and procedures this is how the time is documented. Problems I HAVE found is in OR units being removed from cooler, laid on counter, and then put back into cooler.. OR transfused (not spike time). This requires training. And only reason I found out this practice occurred was on RETURNED units. They put the units back in the cooler, units came back cool. We would not have been wiser... except for the SAVE T VUE on the back of the unit was RED. Why I instituted all units being dispensed to coolers MUST have safe t vues. OR They cannot be returned to be reissued.

Very good point. Some places call women POSITIVE if weak D and do not give rhogam, but with AABB standards re-defined in last few years.... Weak D patients should still get rhogam. AND since reagents are so variable..... perhaps these women DID get rhogam... Was that ruled out?

Do you do Tube method of Auto Control or Gel? Same for all DAT tests?

Not allowed under AABB, CA state must follow AABB standards. Discard of unit is mandatory. And ISBT really does change some old practices..... which were sound and useful for the occassional patient, imo, but alas these improvisitions can't be done anymore unless you are properly prepared in advance with a policy that complies with regulations, approved by necessary powers that be in advance. I HAVE put in place a "Deviation of Procedure" Policy complete with form to be approved by the BB Medical Director. This must be done PRIOR to the event. We are hoping this would stand up to an inspection. What are people's thoughts on this?