Barbarakym

Over the years and working as tech in several BBs, my personal experience screams out for caution. For missed antibody (no antibody id done or error in id) I have seen severe hemolysis ( new to us Anti K, hidden in an Anti Fya ABS, ID not pursued) and re-hospitilization (delayed transfusion rexn due to missed Jka showing dosage...other ab taken care of by ag neg blood)... both patients needing much more supportive care. All caused by no proper AB ID. I was not supervisor or in chain of discepline then so don't know if proper follow up was done.. but to me a VERY BIG DEAL.

I have been wanting to do this as well. However it requires support from administration/management above me to support it when there is a perceived delay. Not to mention our staff is so thin now, a redraw would not be a quick thing. Giving O blood because of slow 2nd redraw would deplete often hard to get O blood so I would want this to be kept to a real minimum. AND I did work for a place where the Drs and Nurses drew the blood. They figured out the need for redraw immediatly and soon were drawing both tubes at the same time, waiting for us to call and say we needed a redraw. I once got physically attacked by a Dr who when I rejected the 'redraw' specimen for not being labeled came down and pushed me against a counter when I would not allow him to label in the BB. His response "I know which patient is which, I kept 'Mr Smith' in my left pocket, "miss Jones" is in my right pocket", pulled out another 'redraw' tube that I had not requested as we had a previous type. Security showed up before it went any further. I can easily see phlebotomists doing this same thing to same themselves some work. If they aren't called for a redraw, the tube could go in the trash.

Mabel, I totally agree and yet I may be over-ruled by those above me. Cerner says they have NEVER had a patient ID mixup EVER and my bosses appear to agree with them. It is hard for me to believe there is a system that can not be bypassed by some overworked employee trying to meet impossible turn a round times. I guess time will tell how it works here. Does anyone who have CERNER with Scanned ID for labels (print at bedside) had a problem of any type?

Actually, the education should come from the Pathologist or a Speciailist in Blood Bank. Medical Meetings are a good place to give handouts and a quick statment by the Pathologist. Mailings from the Pathologist through the Hospital Medical Office with the handout to all doctors on staff should help. We have had the same problem with hospitalists.

List your email address and I will send you my chart and procedure for you to evaluate to see if it works in your situation.

As of now we require the BB armband.I am not comfortable with just regular ID only as it is proven too often mixed up in general lab. If the patient does not want to wear the armband we ask that they come in close to the date of surgery telling them that if there is a problem with the workup there may be a delay in the surgery. We also will draw day OF surgery with the same disclaimer. No blood bank armband, no available T&C. FOR ID I want something specific that is only for BB that is only found on the patient. Then I know that the ID has actually been looked at. I have been told our new computer system comes with a positive ID to print the labels at the time the patient armband is canned while they are drawing. If this is actually true and proves reliable we may drop the second BB Band. But if there is anyway to circumvent this scan and label of tubes..... then I won't trust it anymore than current system.

We don't deliver blood. We are the shortest staffed department. If the 1 blood bank person leaves the dept, BB is basically closed to the rest of the hospital. Whichever dept needs blood, needs to come to BB to pick it up. In cases of expected large volume transfusions.... they request a cooler which we prepare while they are on the way to the BB. ANY nurse can pick up blood, but only licensed personel. Works well...

BUT please come back and tell it what is was. I can't remember my parasit...... but loved that class.

This is what we do as well.

How does this work for the two people read of information at issue (to be sure correct unit is being given to nurse? This is done on the floor with all that noise? We STOPPED delivery even in emergency because of chaotic situations are NOT the best place to be doing unit/patient identification, IMO.

LOL. How many times we get a transfusion workup because temp went from 98.6 to 98.8: That's 2 degrees, right?

So do we. And We make our own Rh Control (diluted albumin to 6%)

I would like to ask the same question for a regular transfusion service. How long do you orientate people before allowing them to work on their own? Do you allow unsupervised work before they are 'signed off'? Is discussion and procedure reading requirement only required at your facility? I have had serious disagreements (me on the side of real training) with managment who do not feel they have this time to give. Am I being too conservative? Our TS is in Ca, USA. TJC is our inspection agency.

I should have added. ALL criteria and how we handle a transfusion reaction was approved and finilized with Pathologist approval. Then there was training of techs and nurses. All new nurses to our facility are given this inservice during their orientation as well.

We have a list of criteria. These are on every transfusion slip (or computer page for vitals, etc). It is this criteria WE follow. The DR can call anyother criteria he/she cares to if they FEEL it might be transfusion related (1 degree instead of 2 for example) we WILL work it up. BUT if the nurse calls us with vague symptoms NOT meeting our critiera we refer her to the doctor. Then it is the doctors decision. BUT if they call and say the patient has 2.3 degree temp rise... It is out of the doctors hands now that we know. Does that clarify?

Cord Blood: Baby ABORh and DAT; Baby Antigen Typing if mom has an antibody.; Biliruben if at risk baby. HOWEVER: IF BLOOD NEEDED: We verify Baby Cord blood result with ABOrh done on Baby (very little specimen needed). We take the Mom's ABS but if mom is not available (Transfer in): Then we DO need to use the Baby (our method is gel, not so much needed as for tube). If mom has an antibody we do crossmatch to AHG on mom's specimen. Later on baby specimen until antibody (usually passive) is gone from the baby's plasma. Though we use sterile docker, so that first unit is good for the life of the unit or until gone. So repeat ABS would be done only if new unit of blood was needed. Neonates without moms with positive ABS or whose own ABS was initially negative do not get further workup during that hospital stay even if they receive blood. Until 4 months of age. Hope I didn't overlook something. But I think thats it in a nutshell.

For transfusion purposes I don't think it matters for the average transfusion. Many healthy people in any given population have Positive DAT. So we do not worry about DAT in our workups. If it goes to Reference Lab because we do not have clear cut answer (lots of positive, Warm auto messing up reactions, Positive Auto at 37 or AHG, etc) then Reference lab does do the DAT. Our worry is if something is coating our cells in our panels (Auto Pos) then Since our transfusion service does not do eluate, I want workup done at Ref lab to be sure there is nothing hiding on the cells.

We have specific parameters for transfusion reactions. If these parameters occur the nurse is to call/ order a transfusion reaction and NOTIFY the dr. So even if the DR says otherwise, we need to do the workup. So yes, we do the entire workup. Which includes discontinuing the trnasfusion except in mild allergic reactions and the Pathologist review. Does the nurse always notify us if the Dr says not to? I could not say, but I imagine it happens sometimes they do not follow policy. But if audited it would not fall on blood bank I would hope as can't be at every transfusion.

1. Not all hospitals run rule out panels initially even with known antibodies. Thus there will be positive cells for those antibodies on the full panel. When the antibody is no longer showing and that cell is negative then that cell can be used to rule out other antibodies. 2. In my BB, as I stated above, I want to verify what is present in that specimen. So at least 1 homozygous cell for that antibody which is negative for the other antibodies pres must be run. As I stated this has helped me verify the patient received blood elsewhere Allowing us to make sure her records were complete at both places. This has happened on several occasions. Reference lab work when sent out this is also done.

You have cells after 4 cycles. I just really still think overfilling is the issue. Why not as experiment adjust so volume is 52-55... Just test it and see. Good luck.

My first thought when this happens is the tubes are overfilling. There is an adjustment on the tubing which you need to do as PM (check volumn dispensed). If move than allowable for the cell washer, the cells are filling up too much and during mix cycle more and more cells get decanted as they 'spill over'. This is the first thing I check and maybe you did, but I don't see it mentioned.

EX: Pt has Anti Fya I totally agree it can be used and do so. Looking for a K on a Fya cell and the cell is Negative one can use that as one of the cells to rule out K. I also want to RULE in what antibodies are present. So I would still look to rule out the FYa and would not accept heterozgyous cells to do that. But 1 Homozgyous yes or no is enough to rule in/out the previous antibody. I like to know this for FYI only. I have found patients going to other hospitals and getting blood by this method when my previous Anti E for example not having been shown in 3 years all of a sudden is 3+.

No. Only when there is Anti A showing in back type.

We make a RH control, 6% albumin: Sometimes our albumin supply is limited so we have added directions for both of the concentrations we are able to buy. 6% Albumin Made from 30% Albumin. Check % § From 22%: 1 ml 22% Albumin to 2.6 ml Saline. § From 30%: 1 ml 30% Albumin to 4.0 ml Saline