Barbarakym

We have a policy that when gel is not at least 2+ on D to go to tube. We do not do the old Du extended D testing except on apparently O neg babies of O neg moms. We do not call people O positive unless they are macro by tube D testing. Weak D people we still call Rh neg. we found after following AABB recommendation of the 90's by calling these patients pos that we gave at least 2-3 people a year anti D. You can not tell the difference at reg BB level between mosaics and weak Ds.

I suggest dropping the solid phase from the name. We use gel which also gives too many non specific reactions. In the old days tube testing also have non specific reactions. Basically no specific antibody identified, clinically significant Ab ruled out). We call all those from all methods Non-Specific Antibody. Have never had a complaint.

I would like any policy on this topic anyone has to share. If possible please attach to an email to my email address: kym993@cs.com. I would appreciate it. I am going to need to attack ABORh policies in first of the new year. Kym

Yes. The theory, per Ortho, is that if the panel is showing signs of degradation it will show up on the weakest cell first. They have validated panel extensively before shipping. ABID is extremely subjective anyway. How many positives and negatives and separation of antibodies present is all up to individual lab. If you get a consistent pattern for a specific antibody showing on your daily QCd ABS reagent you are just confirming what is there. My opinion anyway. So far not questioned by any inspector.

I called Ortho ( we use manual gel method). Their insert also says their panels are validated for much longer than expiration date. So I asked why they added the QC tested 'periodically' to their insert a few yrs back ( was not originally there). Their response to me is that they had no control of how it was shipped or stored. True. They also said periodic needed NOT daily. Or day of use. So to follow ' periodically' a BB needs to define and follow only that they choose to define as periodic. Probably should justify this somehow in procedure. Weakest Ab in panel cell per Ortho is Fya/Fyb cell. What I decided and justified in procedure: QC with Dilute Ab (1:10 or 1:20 to give no more than 2+ reaction. Tested against a Fya+ /Fyb + cell. If it is positive it is ok to use. I don't care if it does not react. I agree with CLIA interpretation. AB I'd is combination of much analysis. AB can only be ruled out with positive reactions. After receipt of panel QC no further QC is done while in date. But once expired we use as 'rare cells' as used to rule out when in date panel does not have all the cells we need. Each out of date panel that is used is QCd per FDA and AABB ruled of 'day of use, exp reagents ok if QC is done day of use'. Again with a positive Fya/Fyb cell. Each expired panel. 1 wk Ab tested on day of use.

We are on tubes. About 25-30 minutes.

I will suggest we try that next time cc don't work. Thanks for the tip.

You don't. So we can't report C3 when it's not working. Need to send to ref lab.

We have often had problems with too weak by naked eye. Is it our technique? How would one make it stronger? We never have 2 lots in date at the same time so using another lot is not available to us.

We have had this same problem last week and it was reported. But we have had this problem multiple times in the past. We usually don't have a second lot to try.

We are manual and do work as it comes in. With my supervisors (lab, I am BB super) belief it does not matter if QC is done 32 hrs after 8 hrs of work as long as it is recorded somewhere on that calendar day. To over rule her I need some type of regulation.

Is there a TJC or AABB or CAP regulation that Daily QC must be done prior to any portents being done once 24 hrs from last QC has been done? I have tried to standardize the time we do QC to be sure we have done QC within 24 hrs but some oldtimers ,including my supervisor , say anytime that day. Which could mean variables from 24-32 hours between QC.

GilTphoto: what corporation are you with? Sounds like mine. We are just transitioning to cerner and it will not be able to be adjusted I told.

We are still on paper system, not computer. We use coolers internally only. So per AABB these are considered storage and not transport. I validated all before first use. The coolers we use are CREDO which are basically iglo coolers with inserts. We have 2 coolers and 4 inserts. Any insert can be used in either cooler. They were all validated independently. Ongoing QC we did a paper log (we are not on computer, another local hospital uses insert/cooler as a pair and acceptance (QC) of temperature on return is done by computer, for us we do this manually). QC LOG has patient name/ time dispensed and temp/ time returned and temp/ If inspection went ok? Credo recommends cleaning each time, so this is part of our inspection process. This has not been looked at by an inspector yet (started this year). Am I missing anything? So far process seems to be working.

Related question: is there any regulation that QC (manual) must be done prior to any patients if not already done within that 24 hrs? Machines will not let you process but manual there is no such external Checks.

Currently we only call something a caa if the auto control is positive at IS ( room temp.). Otherwise we call these irritating reactions cold agglutins (assuming tube abs is pos at is) Our flowchart: Gel abs pos=. Gel panel=. Now if gel auto is pos= tube auto. If tube auto is pos we evaluate. If gel panel has neg auto control= interpret. If all clinically significant ab ruled out and no pattern on panel of lower incident ab we call this non specific ab and just do AHG Crossmatch. Ortho gel system frequently has what I call garbage. High plus, plasma particulates as well as things mentioned will cause pos reaction. What does it matter in real life tech as too much to do and not enough time. In real life it is most important I think to make sure blood is compatible. And thus rule out CS abs. Cold for us we do not try to Id in general. Tube is abs is called cold.

We send waa workups to our reference lab. They do not give us rh or K matched units but units compatible with absorbed serum. I think wasting special screened units when there is no allo antibody is not the best way to care for the patient.

What reporting should be done for a serologic response only? Acute transfusion reactions are noticed/ordered from the nursing unit. How do people order and report delayed transfusion reactions which are discovered by the laboratory? Right now we only report clinical delayed transfusion reactions when clinical symptoms and/or errors in pretransfusion workup and/or when suspicious specimen obtained from new Crossmatch specimen is received.

We have used 1 band also. This is easier with bands with custom lettering/ numbers on them to be copied to the blood draw tubes rather than stickers. Has anyone had trouble with the stickers on the wrong tube or coming off? Kym

There are lots of possible audits. Is JOint commission specific? Vitals and completion of nursing sounds like it should be nursing mgr that audit. Preferably on the transfusion floor. Only way to use it for pi. Nursing at our hospital does 1 in 5 and that was ok. Also Qa audits reasons for transfusion. We set parameters in measurable pt stats (h&h,plt,inr). And we pull all those outside of range and send to Qa. They pull 1 out of 5 to review chart What other audits would meet JC requirement? I did not see where they demanded anything specific. Just that some audits were being done.

We have found spinning 15 minutes at 3600 RPM takes care of nearly all the junkiness of using plasma. Though I am talking issues on gel system (mixed field,non-specific antibodies). Not just rouleaux or colds cause interference but high protein values and hi okra and in diagnosed stuff. Except strong strong colds which interfere with front typing have had NO IS problems at all. Maybe because of how we spin?

Thank you for clarifying.

Thank you.

Thank you. Actually I am wondering from the blood bank perspective. Jka displays as delayed transfusion reaction I believe. So should we be testin h&h, billiruben? How far out? What type follow up tests & what time period? Not sure how Well versed or pro active medical director will be. We r small hospital without much experience with positive trans reaction ( mostly febril )