mollyredone

Our Hematrax is not tied to our computer system (Meditech) so we have to manually input if the unit is CMV negative. It would be nice if it were automatic.

Scott, Our 5 day thawed plasma (which is all we make) used to expire at midnight as well. But the nurses are documenting transfusions in Meditech now using TAR, and they scan all the barcodes. Meditech shows the component as having been made at a specific time, so that is what we have to put as the expiration time when we print our Hematrax labels. Does that make sense?

Mabel, we just started using the buffered gel cards for our DATs. We use 3% A2, complement control cells, and patient sample and dilute to 0.8% with MTS Diluent 2. We also run controls each time, since that's really the only way to make sure you have added the anti-C3b,-C3d! We do IgG in the IgG gel cards and got rid of polyspecific AHG.

AMcCord, Who manufactures your reagents? We use Immucor and they state you "may" wash the cells, but it isn't required. We do wash cord bloods 3 times. The staff in family birth usually get as much blood on the outside of the tube as in the tube! Gross!

Validation for this is no different than for any other thermometer. Check it annually against an NIST thermometer. I just lay the thermometer on top of the "scale" thermometer. If the temperature it is displaying matches the NIST thermometer, you are good to go. You should also check it against a unit by placing the unit on the thermometer, then fold the unit around your NIST thermometer. Should agree within 1 degree.

We check it annually against an NIST thermometer.

I mentioned previously that we have two different forms. One is for emergency release, usually to the ED and we get those signed afterwards. The other is a high risk emergency release, when we know there is a problem, such as an antibody, and they want units before we can antigen type them. In this case, we request that it be signed prior to release of any units. Don't want the doc to say "Oh I didn't know there was really a problem!" But we are in the process of changing one aspect, and that is a statement on the form that the doc has informed the patient of the extra risk. The patient really should be told that there is an extra risk, especially if it is just for a low Hgb and not bleeding out from a gunshot. We had that happen this past week. A patient we hadn't seen before came in for a TS half an hour before surgery. Gel screen, panel and tube screen were positive on all cells. Sent it out and it came back as a warm auto, anti-K, anti-Jka and anti-S!! Incompatible crossmatches (warm auto) One unit was transfused. Hgb dropped again. Hospitalist discussed it with the patient, who wanted to talk to family about it. He didn't know anything about a problem with the first unit! So that's where we are heading. If I were the patient I would want to know!

So I got some buffered gel cards to run anti-C3b C3d for complement testing in a DAT. How many samples do I have to do to validate this method? I ran the last DAT survey from CAP and it worked out perfectly. For those of you who use this method, do you run controls with each sample, since you have to remember to add the antibody? Or do you run a patient control with each sample? I'm trying to get rid of my poly reagent and complement check cells. Appreciate any help!

I followed up with Immucor and was told they will have the answers webinar up in the next week or so.

We use Safe-T-Vues on any units going out in coolers. We have an outpatient clinic which is in the hospital and I validate their coolers. If a patient is only getting one unit I don't always put one on-it's the second unit that is vital. We even have a canned comment that we enter when we issue that states that a Safe-T-Vue is attached and it is issued in a cooler. That way if anyone looks at that transfusion and wonders why it was started 3 hours after it was issued, we are both covered. The ED is notorious for returning units and the Safe-T-Vues are red. I like Safe-T-Vues but you have to be careful applying them not to touch the center part or it will turn red due to finger heat! We bought the Rapid Response thermometer that looks like a scale. Wrapping the unit around a thermometer was not real easy to do. It isn't cheap ($500) but it's easy. http://www.thermcoproducts.com/BLOOD-BANK-Thermometer.html?zoom_highlight=RAPID+RESPONSE

Our procedure says that + 1 degree is acceptable for blood bank.

If you are an Immucor customer, you can sign up for their LEARN webinars here: http://extranet.immucor.com/EN/Pages/default.aspx Then select webinars. They have the original webinar up, but not the follow up webinar, which was answers to questions about BB proficiency, competency and QC.

We do separate into another tube for antibody ID, for the same reasons as Mabel, but when it is done, we pour it back in the primary tube. We use a 6 ml EDTA tube.

I agree that if I'm quick, the chart does not spike, nor does it show up in Isensix. Good to know it could be contested! I have another question. COM.30725 Non-certified Thermometers If digital or other displays of temperatures on equipment are used for daily monitoring, the laboratory must verify that the readout is accurate. So if we use the digital temperature, does that need to be checked separately against an NIST thermometer? What if we also have Isensix and it is checked against an NIST thermometer annually? Is that sufficient correlation if we show our digital readout matches Isensix? Hope that makes sense!

We do keep unconfirmed units separate, usually in the bag they came in. But we do put stickers on them-little round green Avery stickers , 3/4", and our SOP reflects that. Our computer will also not let us use an unconfirmed unit.

Goodchild, That is our issue also. They call many more MTP than turn out to be. One of our last ones had all the units returned to us...out of temperature of course. Throw away four O Neg PRBCs and 2 liquid plasma. Another MTP on a fellow with a 1.9 hemoglobin...they used 1 PRBC and one FFP. Or they will call an MTP, get the first pack and then want 4 more FFP-is this the massive protocol or ordering a la carte? Sorry to grumble.

Brenda, didn't you see the attachment I put in my first response to this? I'll attach it again. Immucor does underline additions or significant changes. changes.pdf

Auntie-D, I'm pretty sure Brenda had already done that and knew it was a different version before she posted. She didn't know what had changed.

Immucor does that. They underline anything that has changed and use a closed triangle for anything deleted. I've attached a copy of one from 2010. What bugs me we get a new insert in 2016, and it was changed in 2013! Where has it been all this time??changes.pdf

Wow, who knew this could happen at so many hospitals? We have the same issue. L&D insist on glass red top tubes for vaginal deliveries because they are sterilized in the pack. However, we get 6 ml EDTA from C-section deliveries!! Plus the red tops are usually smeared with blood. It's disgusting!

Thanks Malcolm. Each lot is different cells. Why would you expect exactly the same reaction? Are you going to send back a kit because you saw 10 on the old lot and 7 on the new? Are you going to use the old anti-D because you got a stronger reaction? What about not mixing components from different kits? As long as you get a positive, it's positive! (These are rhetorical thinking out loud questions)

And we just keep two PPH on the shelf as a level III trauma center.

I listened to that webinar as well. The procedure that was in place before I took over says to run the new anti-D with the new and old positive and negative controls. What is the point of running the new controls with the old anti-D? Several times it is the same lot number from kit to kit. So, if the old controls test appropriately with the new anti-D and the new controls test appropriately with the new anti-D, I don't see that there is anything wrong with that. Would appreciate feedback.

We don't do IS XM on gel XM because our computer is set up to detect ABO incompatibility. However, if the computer is down, our procedure states that an IS needs to performed as well. Maybe I will put the charge in for that.

No, it didn't seem cost effective to us since we can just rotate out the shortdated ones with our blood supplier.