Byfaith

We save the dry ice we get with frozen blood products or tissues in a Styrofoam box with a lid in our deep freezer (-60C). Lasts a week or so depending on how often it is opened, how full it is etc.

New York State specifically requires this annually

We use EXM on Cerner Millenium. I'll try to answer your questions... For Blood groups, if you ever change the ABO-Rh interpretation it will disqualify EXM. If you are only correcting a reaction strength or something like that you can still use EXM. RBC units not entered electronically cannot be used in EXM. There is a workaround to remove the units from inventory if someone has manually entered, and subsequently enter them electronically. I hope this helps!

I tell my techs that the abbreviated panel performed when RhIG was recently given is like running an antibody screen using all RhNeg cells. It is not designed to identify an antibody, rather to detect the presence of clinically significant antibodies. In reality, every patient we get a negative antibody screen result on has not been subject to strict "rule outs", particularly if you are using a 2 cell screen.

In our BB system (Cerner) the blood status would first be considered Available, then Crossmatched, Dispensed (pick up by nursing), and presumed Transfused 30min after Dispense. We do somewhat use Dispense and Issue interchangeably in some of our SOPs. As far as when the blood is crossmatched and ready for pick-up, we would either say the blood is ready or crossmatched complete.

That thought crossed my mind also - 86yr old woman - who knows?! Regarding the clones in Anti-D reagent, the results in 2009 were 3-4+, but I guess strength doesn't matter if a clone is either going to react or not react with this particular patient. Interesting case, whatever it is!

Hope some expert can shed some light on this. Patient history O Pos, done on 3 seperate samples in 2009. Patient received 1 unit rbcs in 2009. Today, patient is O Negative, done on 3 seperate samples, one of which was a witnessed draw by myself. Patient denies Bone marrow or stem cell transplant - diagnosis is CML. My best guess, based on Google, is a rare phenomenon seen in CML patients due to a mutation? Of course, she was given O Neg rbcs.

Has anyone else seen a case of WAIHA that was apparently caused by Nuedexta? Given in this case for PsuedoBulbar affect in a patient with ALS. Seems to be a particulary difficult case for us to work on - most patients we've seen with WAIHA can be effectively worked up using LISS. We don't do Autoabsorptions so sending to the reference lab for his frequent transfusions. Just wondering, as this is a new one for us.

So after an unforunate (and reportable) event where an ECC patient got transfused with RBCs instead of intended FFP, we made changes in Cerner. There is a crossmatch orderable and a seperate Transfuse orderable - the Transfuse order generates a page on the Blood Bank printer, which must be on hand prior to issue. Exceptions for emergency, MTP, and OR cooler issue. Babysitting at its best!

Thank you to all for an elightening discussion! Good food for thought regarding letting the analyser decide - we may consider that concept.

There is older literature referring to the concept of hemolysis as a positive reaction interpretation. I believe this is relavant only to tube testing. There is also the fact that using EDTA samples complement does not come into play and therefore no hemolysis of test cells? I believe our cutoff is random, going along with our chemistry laboratory cutoff.

We have always used a cutoff of 50mg/dl hemoglobin concentration (Visual color chart). We use EDTA tubes and Provue analyser. Are we overdoing it? Sounds like many places take everything but gross hemolysis, and even those on an urgent case.

We are looking to bring DTT treatment in house as well. Still working out the details and hoping to have the same question answered - does anyone test the treated cells in MTS-Gel? It seemed to work well for me when I experimented with it.

Thanks for your response! So another somewhat gray area - sounds like we will continue our practice of having our IRL work them up.

Another question on eluates - we often get apparent "panagglutinins" when testing eluates. Our policy has been to send these samples to our Reference Lab because we cannot perform rule outs. Is this appropriate or over the top? I kind of like the terminology "newbie" used "All cells reacting, no specificity".