mollyredone

I even have that section bookmarked in our book. It can help explain a lot of reasons for a DAT to be positive.

So how long do you store the cord blood? How long are they good for refrigerated? Do you get cord bloods on all babies? We would like to quit performing ABO and DAT except for O moms and Rh neg moms, but have a sample as above in case the baby is jaundiced. Thanks!

Same with us. Then we have the bag if it needs to be cultured. Doesn't work for delayed reactions, but I would question the suitability of culturing a bag from several days ago.

We don't have bags returned to us. We take off 2 segments when we retype the units and save for a month, 1 week in each bag. It's easy to find by when it was retyped in the computer and there are only four small bags to check for the correct date.

We have Meditech Magic and we can scan the barcode for CMV negative and it is accepted.

David taught me this! We switched to gel for both IgG and complement DAT and use the buffered cards for complement and require QC with every patient test to verify that the anti-sera was actually added, using A2 cells and complement check cells.

As Eagle Eye said, check into low titer A plasma. We use it for all our massive transfusions and emergency release, in the form of liquid plasma. They have quite a few studies done (including over 8 years at Mayo) with using A instead of AB. And of course stress patient blood bank specimens ASAP. We actually quit carrying O plasma since it was outdating and use A instead. But we have very few "real" MTPs.

We have a form to fill out and usually have the tech repeat the test and comment on anything that might have caused the problem. PROFICIENCY REVIEW.docx This is a copy of our form.

Do you have Meditech? I saw a place I could print a list putting in specific antigen typings, but it prints one page for each antigen and blood type. Kind of tedious.

I understand what you're saying. It has happened here as well. But we also document unit status (CMV, HGB S and antigen typing) in our LIS, so it would be caught when the unit was being crossmatched. Do you not do that at your facility?

Our nurses use TAR. They scan all four barcodes, so they also scan the product code. We try not to crossmatch units that have the same DIN to the same patient.

Brenda, why do you need the unit number on the label? You are attaching the label to the unit, correct? We have red antigen positive labels and green antigen negative labels. We also document in the blood bank module that the unit is P/N for an antigen. That way if there is a label that comes off the unit, we can still see that the unit has been tested and verify it in our antigen testing log. I have found that attaching the label to a little bit of the whole unit label helps it stick on better.

Ditto what AmcCord and Tricore said. The medical director's name is on every result. If he/ she is unconcerned that is a very bad situation!

That's an awful situation! I have had to retrain several techs who made mistakes. How long do you usually train them? I would document everything he does wrong. Does your procedure state that you have to put your results in immediately? Ours does, since that is what CAP requires. What's worse is that your higher ups aren't alarmed by your observations. If he is not following procedure, or changing his actions based on what you have communicated to him, I would not sign him off as being competent.

We have Meditech Magic and I believe only "Super Techs" or supervisors can edit the BB specimen expiration. It's under Requisitions, LIS menu, and 29 "edit BBK specimen expiration. I don't do it often because we are a small hospital, but if the patient has been admitted for surgery and hasn't been transfused/pregnant in 3 months, and then needs blood, I will extend it for a couple of days. I have to admit I haven't tried it with EXM though. I'll have to try that.

We don't usually crossmatch before antigen typing, but we charge for every antigen typing, positive or negative. Use judgment-don't antigen type 10 units to find one K-negative unit. We also charge if there are multiple antibodies-3 antibodies, 2 units is 6 antigen typing charges (at least).

Our computer system is validated to detect ABO incompatibility before we do any kind of crossmatch. If I pull out an A Pos PRBC for an O Pos patient and scan the unit, Meditech will tell me the unit is not ABO compatible whether I am performing an electronic crossmatch, immediate spin crossmatch, or an AHG crossmatch.

We also allow phone orders for emergency release and get the paper signed afterwards. The only time we insist on a signature before issuing is if we know there is a problem with the patient, known antibody and no screened units, etc. We feel this is important enough to have the paper already signed so the doc can't say, Oh we didn't know there was a problem... That form is called the High Risk Transfusion form.

THANKS FOR THE CHRISTMAS PRESENT! FRUSTRATION RELIEVER!

We are inspected by CAP. Everywhere else in the lab QC, surveys, competency etc. only need to be kept for two years, but it is 5 years for blood bank.

Thanks! I wrote my EXM procedure so I listed criteria where the EXM is eligible (as well as a flowchart for tech use) and then listed all the computer system alerts that pop up if the criteria is not met.

Oh You!! ER did return some platelets on ice not too long ago, with the whole massive transfusion pack of 4 PRBCs, and 2 FFP! Obviously not needed!

We do all DATs in gel. We do baby DATs by washing the cells, spinning to concentrate, taking 10 ul in 1 ml of MTS buffer, adding 50 ul to an MTS IgG card and spinning. We do complement DAT by the same method, using a buffered gel card, 50 ul of 0.8% washed cells. We always run a positive and negative control, since we want to make sure we have added the 25 ul of anti-C3b, C3d to the card. Otherwise everything will be negative!

When we had our shooting here two years ago, we just handed out emergency release OP and ON PRBCs to the ER. There was no documentation regarding these units, and we still don't know which patients received which units. They did not ask for blood for a certain patient, just that they needed units. One doctor charted that he gave a unit of platelets to a patient-we didn't issue any platelets.... To comment on Carolyn's post, if we have another mass casualty, we will send a med tech down to the ER with the products in boxes with ice, and the tech will coordinate with the nursing supervisor to make sure when we hand out a unit that a sticker gets put on that patient's chart.

That's what we do as well. If the unit comes from the supplier with an antigen test result on a separate tag, we do not retype it. We also get a historical database from our supplier to test our own units.