mollyredone

double post

Thanks everyone.

We have an 11 month old with TAR syndrome who is being transfused regularly with plateletpheresis. When she was first born we didn't perform a back type. But a couple of months ago I started to think we should do one, as she should have formed antibodies at about 6 months. But her backtype is not positive unless it is incubated at 4 degrees (with a control of course) for 15 minutes. Does anyone know if this is a symptom associated with TAR? Thanks! Mari

Mabel, do you have the JC standard number for that? Our policy states that the doctor can decide whether to call a reaction or not and we're lucky if they even call us! They are inspected by JC so it would carry more weight in getting that changed. Thanks, Mari

Megan, We use Meditech and when a patient has an antibody we don't do an IS, because our LIS is validated for ABO incompatibility. We order XM GEL and enter our results there. In the field for XM IS we just enter TNP(Test not performed.) As several people have commented, if the computer system is down, we must do an IS XM for ABO incompatibility. Hope that helps.

Initially we do clerical check, and check on pre and post transfusion specimens for hemolysis, icterus, DAT and type. We only request a urine specimen if any of the previous results are positive. edited because the font was so small!

We are doing titers on a prenatal patient with anti-c and anti-Fyb. Lots of fun!

I would discuss this with the medical director, since ultimately it is the medical director whose name is on the line.

Our system is like PBaker and AMcCord. We will occasionally get samples with the mother's demographics, but Family Birthplace has to come down and bring the right demographic label. Our samples from C-sections are pristine, while the ones from normal deliveries are often gross with blood. An email stopped that for the most part, but I have to say, Really? You have to be that sloppy???

I agree with Mabel (as usual). I have had a couple of techs who won't rule out antibodies on a panel with just one homozygous cell with a negative reaction. My response is well you better not ever turn out an antibody screen as negative unless you run additional cells to rule out the antibodies!

We also developed a flow chart to deal with gel anomalies. One time someone did a gel screen that was iffy and then had a negative tube screen and did IS XM. The patient came back days later with a delayed transfusion reaction and identifiable antibodies. So now protocol is gel screen, if positive, gel panel. If results are iffy, tube screen, but always gel XM.

CAP TRM.40650 states that a procedure to demonstrate ABO incompatibility, either a serological crossmatch or a validated computer system is required. We have a validated computer system and have never been cited.

We would only do a DAT if the FMH was positive and the mom was not weak D positive. If the DAT is positive or the mom is Weak D positive, the FMH is invalid and we would report it out that way. We don't want to report out a positive before sending it out for a fetal Hgb F, if the FMH is invalid.

We use the pneumatic tube system as well. But our protocol is that the floor can't return the unit via tube system. We send ours up by secure send so they have to punch in a code to retrieve the unit from the tube system and we never set it up so they could tube it down securely. I guess we would probably resend it by tube system. I hadn't thought about it. Mari

Thanks for the input. I thought that chart was nice, but I wanted to make sure I wasn't including anything that hadn't been documented by the company. I will just leave that part of the chart out. Mari

positive baby DAT.docI read a procedure someone had posted using the new FMH RapidScreen by Immucor. They had a nice table in the procedure that stated when it was appropriate to perform the FMH. It was not appropriate to perform it if the mom is Rh pos, the baby is Rh neg or weak D pos, or the baby or mom has a positive DAT. I found references in the package insert regarding everything except the baby having a positive DAT. Does anyone else have this in their policy and what are the references you have? Thanks so much, Mari

I am attaching my two-part flow chart for ABID. I was in the same situation: many different SOPs but nothing to tie the workflow together. HTH, Mari ANTIBODY WORKUP FLOWCHART.doc ANTIBODY WORKUP FLOWCHART 2.doc

Thanks for your input David!

I have a question about filling out transfusion forms. Many times when I audit them, something is missing, whether it is the volume of the unit, the post breath sounds, or BP, even initials for verifying. How do you handle this? If it's on the form, I think it should be filled out. We just got a new QA person who is more interested in this, but I haven't gotten any feedback yet. Any thoughts? thanks, Mari

We do as DebbieL does; if antibody screen is consistent with the previously identified antibodies and the gel crossmatches are compatible we only do a panel every 30 days.

We would only perform a D/Du test on a mother with a positive fetal screen, preferably on a pre-delivery sample.

Same here.

We only use CMV PRBC units if the patient is a transplant candidate or has had a transplant and is documented as CMV negative.

I wonder how many doctors will still want to give the patient platelets!

That's what we would do, since any later typings of the baby might look negative, and we don't look at the tubes microscopically or do a Du on adults.