mollyredone

The rosette test, or fetal screen, is only for use after delivery of all products of conception, and then a venous sample is collected 1 hour later (or it can be longer). We use the FMH RapidScreen by Immucor, which is the same one Teristella mentioned.

We also have many issues with MTP and emergency release blood. Our ED docs have been overcalling MTPs, but at least they are getting better about the lab draws necessary. We had two this week. The first patient was shipped to another hospital, and 4 ON PRBCs and 2 liquid plasma were returned to blood bank-all out of temperature. They were written up as an incident report, stating it was a waste of over $1500 worth of blood products. I heard that our pharmacy billed the ED for a dose of K-Centra that was made up and not used-$3000! Do any hospitals on this forum charge another department for blood that has to be destroyed? The second MTP came back with 2 PRBCs. (Our pack is 4 PRBCs and 2 liquid plasmas to start) Unfortunately they also returned all of the transfusion forms, so I doubt whether we will get any documentation on the transfusion of those units. We don't deliver blood-they have to come up and get it. If the patient has arrived, they bring up a patient sticker, because most of the runners didn't even know who the blood was for, and we weren't comfortable with that.

Not so far. I haven't heard back from my medical director. I would think it would only affect patients who were at risk for CMV or TA-GVHD. I have also checked my transfusion reactions and haven't encountered one of those units yet. So my feeling is if they haven't had a reaction by now, they probably won't or we would have heard about it.

Yes, but all the units that were recalled for us (so far) had already been transfused.

Santa Barbara is gorgeous! Except for the wildfires of course!

I've responded to this before. We live in a small town and don't have people coming to have surgery here from 100 miles away, so we use 84 hours as our expiration time for everyone. If you live in a large city, I can see how that would be a problem for pre-ops. However, if a pre-op patient is in the hospital and on the fourth day they need blood, I can extend the expiration time if the pre-op questions on transfusion and pregnancy have been answered in the negative. It doesn't happen often.

We give irradiated platelets and red cells, and CMV negative if tests show they have not had CMV (neg IgG). Plasma as is. As far as changing blood types, we give compatible to both types until total conversion.

What we do is make a fresh cell suspension and then wash three tubes (one for poly, one for IgG and one for complement) with one drop each. If the poly is negative and check cells work, we toss the other two tubes.

I wouldn't be doing a DAT if my auto-control were negative! Since all we stock is IgG cards, maybe I'll look into buying buffered cards and adding my own complement like you do. We do tube DATs for hemolytic anemia and 99% of them are negative with poly so we quit right there. What kind of expiration date do the buffered cards have?

I agree with David and R1R2. But here is a copy of my comparison form. I use two positive and 1 negative AB screens and 1 negative and 1 positive DAT every six months for comparison between gel and tube. METHOD COMPARABILITY WORKSHEET ABS.xlsx

If your computer is validated to detect ABO incompatibiliity you do not need to perform an IS XM. Our procedure says that only if the LIS is down that we need to perform an IS XM for antibody patients.

Thanks for the replies. We just keep two sheets for each workup (screen and panel), so nobody's file is very big. I'll just move all those workups to another shelf. I used to use local obituaries and the Social Security Death Index to thin down my folders, but that site has become very unfriendly to use.

We report them out as "Probable passive D due to RhIg dose". But do you keep the panels and treat them as antibody workups? Or are all your worksheets scanned like Auntie-D's?

We are running out of room on the shelf for our antibody patient workups. We keep them in a manila folder and I try to pull out any deceased patients and put them in a drawer for another 10 years. We have so many Rhogam "anti-D"s. When complying with CAP regulations, would these even be considered antibodies? Could we just document in the computer that it is probable residual RhoGam, and the date of the injection and not create a new folder? That way it would pop up whenever that patient gets another antibody screen. Or would we have to save the panel worksheets to prove that we had determined it was probable RhoGam?

Same here.

If the pre and post DAT are both positive, do you always assume it is transfusion related? What if the pre antibody screen is negative? Do you look for medications that might cause a positive DAT? We don't do elutions here and it would really delay future transfusions if we had to send both specimens out. I know I can get approval for high risk transfusions if the medical director okays it. AABB standards state that if the post DAT is positive to perform a DAT on the most recent pre sample, but they don't say what to do after that. Does anyone check for icterus on the post sample? Our current policy states to check for icterus if it has been 5-7 hours post transfusion.

I am interested in this as well. I'm having a hard time getting a copy of AABB Guidelines for Implementing Electronic Crossmatch. It only comes up as buy for group, and I don't have a group! Does anyone know how I can get a copy? Thanks!

We also compare DATs since we perform them in gel (newborn) and tube (hemolytic anemia)

Can't the Bloodloc bags just be cut open? That's not following protocol, but I could see OR doing that in a hurry.

One of the problems in the US is that we don't have a national database for blood types. So if a patient were genotyped here as weak 1,2 or 3 and got Rh positive blood and no Rhogam, another hospital wouldn't know about it unless the patient presented a card from us stating her status. Is there a national database in the UK, Malcolm? At what age would you start genotyping females for weak type 1,2 or 3? It would be so nice to have this standardized, but all we can do is call another hospital if the patient has been transferred to alert them of an antibody situation. We do give the patients ID cards for their wallet, but that doesn't always get presented.

I am attaching a copy of our reagent quality assessment. We separate our products specifically and have a binder with all the package inserts and then document lot, receipt, in use, expiration date and inspection. This form goes behind the package insert, so we can see it. BB REAGENT LOT.xls BB RM Quality Assessment of Received Reagents.doc

Does that include 5 year olds?

Sorry Malcolm, we would not send any female of child-bearing potential out for genotyping (which we are not doing yet anyway) unless they are/were pregnant. I don't think ACOG is addressing 5 year olds. Males would not be genotyped either. Can't they form anti-D? Even if it won't precipitate HDN. The purpose of the genotyping is to prevent excessive use of Rhogam, as well as unnecessary utilization of Rh-negative PRBCs. And our cutoff is <55. P.S. I was just referring to FMH in my original post.

Are you saying you perform weak-D testing on all females of child-bearing age? Do you then send it out for genotyping to confirm that they are Type 1, 2, or 3 and cannot make anti-D? We don't do any weak-D typing on females unless they have a positive FMH and then we cancel the FMH and order Fetal Hgb F. We only do weak-D testing on babies if the mom is D-. If the baby is weak-D pos, we still report out as D-, since we wouldn't perform a weak-D on an adult. We haven't gotten into genotyping yet, although that is the guideline of ACOG. There are a lot of interesting articles about it.

I know this is an older topic, but here is a copy of our high risk/emergency release form. When it is emergency release for the ED, we are not as picky about getting it back, usually give it a day. When we know there is a problem with a warm autoantibody or non antigen typed units for an antibody patient we require the form be signed before issuing any units. HIGH RISK TRANSFUSION & EMERGENCY RELEASE FORM.doc