Gnapplec

Our lab also transitioned to treating our own cells for adsorptions for complex workups but for only a short time of a few years. Our hurdles forced us to discontinue this level of service again as mentioned keeping staff competency, TATs without 24/7 coverage and limited flights for samples to arrive. We had the advantage of our sister IRL to provide absorbing units for us on a regular basis otherwise it would have been very difficult. It was fun while it lasted but if there is any question in the long term viability and ROI this route isn’t for everyone  and of course the main concern is providing the best patient care  if you don’t have a team that can staff a schedule as well as handle the 8+ hrs one sample may take to finish....this may not be for everyone.  Hope this helps
 
Let us us know how this goes !!

Our lab also transitioned to treating our own cells for adsorptions for complex workups but for only a short time of a few years. Our hurdles forced us to discontinue this level of service again as mentioned keeping staff competency, TATs without 24/7 coverage and limited flights for samples to arrive. We had the advantage of our sister IRL to provide absorbing units for us on a regular basis otherwise it would have been very difficult. It was fun while it lasted but if there is any question in the long term viability and ROI this route isn’t for everyone  and of course the main concern is providing the best patient care  if you don’t have a team that can staff a schedule as well as handle the 8+ hrs one sample may take to finish....this may not be for everyone.  Hope this helps
 
Let us us know how this goes !!

I am just wondering if anybody (any Blood Centers) has been labeling units with historical antigen typings since 2017 FDA guidance came out. For those who are doing these, I am also curious to see what kind of processes you have in place and which antigens you are labeling using historical antigen typing. *FDA guidance document attached* 
UCM534978.pdf

Our collection facility is going to start sending out patient samples and donor units for RBC genotyping on the Immucor Bioarray HEA system and I'm curious as to what this could mean.  Will they be able to label units based on the HEA results since it's FDA licensed?  will they still need to confirm serologically?  Will they need to run more than one donation from the donor to confirm the genotype ("predicted phenotype") before labeling it or confirming serologically?  How would this differ if they were using a non-licensed platform like the Grifols ID Core from Progenika?
Thanks for any guidance!

I agree with Cliff and AMcCord. I suggest to first determine if your lab can afford the time, i.e. do you have enough techs to work-up warm autos that require allo adsorptions in addition to your current work load. If you can and do then look for the answers to your list. 

Our Preop patients are TS only. Then when they come in the day of their procedure, the orders are entered (by the amb surg dept) for the products requested on that day's admission. The date of surgery is considered DAY 1 for the preadmission TS sample (even though it's entered for the actual collection date) and that specimen's crossmatches reflect that date and will have a 72 hour life at that point. We have Meditech also (:mad:). If the patient is not crossmatched that day and then the next day on the floor they order a unit, the specimen is now 1day old and we'll backdate the product order to reflect that, etc. Our preop TS specimens are good for 14 days. If the surgery is done on the 14th day, then the specimen could not be used on the 15th day and a new TS will have to be done. If the patient was recently transfused or pregnant, then a new TS specimen will be requested on the day of surgery, a new IAT performed as a confirmation that no previously undetected antibodies have formed, but all off the books (no order or charge) but results documented in BB.
We in BBk, having a copy of the surgery schedule and the signed preadmission testing document signed by the patient which notifies us of any recent transfusions or pregnancy. If the patient has an antibody, we automatically crossmatch 2 units the day before to save time.
Also, the day before surgery we call the ambulatory surgery department to notify them of any patients that require a 2nd specimen for ABO confirmation. When the patient comes in the next day, they obtain the specimen when they start the IV etc.
We also scan the surgery schedule for any patient that may not have a TS yet are having a procedure that normally warrants one. We'll notify the amb. surg. dept. as a courtesy that they may need to order one.
It's worked out quite well for us. I hope this makes sense, it's a rather simple system that appears complicated when describing it.

What unidentified antibodies??????????????????????????????????!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Hi all,
I admittedly have been absent from these forums for an extended period of time.  It's good to see some familiar names on here!  It's equally good to see some new names on here as well. 
I was was just reading through a forum and saw some posts that involved name calling and general disrespectful behavior.  While I appreciate a good debate and a witty discussion of relevant topics, I find neither of those actions as fueling intelligent conversation.  I considered calling out this individual in the forum, but then discovered that there was a way to report the post to the administrator.  If you also feel that these comments are detrimental to furthering productive discourse, I would encourage you to use the Report feature.  We, as a community, do not need to tolerate such behavior.

https://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/UCM425952.pdf
This is in Draft status, but should be finalized this year.  Once finalized, FDA will give 2 years for implementation.  Transfusion services should not be mandated to make changes until some time in 2019 or later.  There are some misstatements in some previous posts that should be clarified.
PAS apheresis platelets can be stored up to 5 days and must have a "safety measure" test within 24 hours of transfusion if transfused on Day 4 or 5.  The use of platelet additive solution does not confer any protection against bacterial proliferation. Plasma-stored apheresis platelets can be stored up to 7 days and must have a "safety measure" test within 24 hours of transfusion if transfused on Day 4, 5, 6, or 7. Pathogen reduced apheresis platelets can be stored up to 5 days and can be transfused up until expiration without additional testing.  

Thanks, Cliff, for the Velcro idea! It took a few hours to get all the old labels off without alarming the poor fridge but I relabeled our shelves this week.

I may go to the extreme but when we receive surveys all of the "patients" are registered in the computer and the appropriate tests ordered. The vials can then be labeled with barcoded patient/test labels and can be scanned. I also enter the "donor unit" into our inventory and print donor unit label for the specimen and place the DIN label on the vial. This way everything is done in the computer just as it is with a real patient. When the tech has completed testing they can print their results from the LIS and if need be I can always go back and look at the results.

Thanks much for all the information. This Blood Bank community is of immense help & I really value your opinion. I am fairly new at my job as a Lead and counting on you for advice. 

Yay, i'm soooo excited to be part of this group of blood banking professionals.  I've been a med tech for almost 20 years now. Most of those years as a generalist in bloodbank, chem, heme, micro, but Blood bank is my favorite department.  Did 5 years in supervisory position, changed hospitals where i was a night shift coordinator, i couldn't do that for long.  Now i work days as a blood bank med tech at a very prestigious hospital in the Chicago land area.  Everyday I'm learning here and always excited to come to work.  Looking forward to learning from this group as well.  Thank you!!      

You are to be commended for going the extra mile to ensure safe patient care.
Like others here, i would suggest at this point that you put all of this stuff into a document (impassionately written of course).  End with your concerns about patient safety, corporate compliance, etc.  Be sure to list all of the management people you have alerted with dates.  Then send the email it to all management and administrators above the BB and Lab (including directors and V.P.s)   You should have a corporate compliance officer you need to send a copy to as well.
Hopefully some responsible person will realize that they can no longer ignore a disaster waiting to happen, as you will have created proof that all responsible parties were alerted.  
Scott

If the midnight shift tech did allow him to do this, then there should be signed and dated documentary evidence from this midnight shift tech that they did indeed watch him do everything, and then, if it were me in charge, the midnight shift tech would have to explain to me, in words of one syllable why they had disobeyed my instructions in my email.
I agree entirely with the posts above that you MUST take this to HR, and take others with you if you possibly can.

I know it's happened, but the number doesn't seem to be very high.  (I'm going strictly on memory and not actual numbers).
The problem with that is, most of these type of people tend to be traumas, not the chronically transfused people you see often.  Once they've been discharged, we may not see them again or it may be years later. 
It may sound crass, but for it to be a problem, they need to survive the event which is causing them to bleed to death.  Developing an antibody (ANY antibody) is the least of their problems.

I would agree with mollyredone, but would go further,
Not only do you need to record everything you say to him (and get him to counter-sign the record), you need to record everything you tell your own seniors, and get THEM to counter-sign what you have told them.  THIS PERSON IS DANGEROUS.  You, as a conscientious employee, should not have to take responsibility for this person, but, if the worst happens (and it well could), you want to make certain that you are not held responsible in law, but that the finger is pointed in the right direction.  If you get your own seniors to counter-sign your written concerns, you will, not only be protecting your own future, but will also cause them sleepless nights until they do something about the situation.

Good point.  Focusing on how clean the cooler is does not help the fact that the blood bag itself is probably fairly dirty and dusty. With all of the production steps st the blood center, centrifuge cups see hundreds of units a day and are only required to be cleaned once per day.  Add the handling at the blood center from tray to tray and transport, it's not the cleanest after all those steps Unfortunately. 

Just curious: Other than common sense, is there a regulation that says coolers or blood boxes/transports need to be cleaned?
Obviously, if there is some overt issue, they should be cleaned, but in practical terms, the OUTSIDE of blood bags do not claim to be clean/sterile. I can't imagine that the coolers themselves are taken into "clean" areas like ORs, but if they are, that's a different story - they should be clean INSIDE and OUT. While the Blood Bank is probably cleaner than the "smoking" shack, I'm sure it's not claimed to be clean in the clinical sense.
As a parallel.....how often are blood storage refrigerators and freezers cleaned? Certainly not every time they are used.
Perhaps more focus should be on coolers returned with noticeable blood contamination: where did it come from?, was the blood inside compromised?, did a unit of blood with a hole in it get transfused? Of course, that still implies an inspection process, but doesn't necessarily mandate cleaning.
Just a few brain drippings, no soap box or intent to offend.

It isn't. That's why most blood suppliers went to pooling and pH testing (using the FDA approved methods) before shipping platelets.

Can you please share with me the current practices of your hospitals for neonatal thrombocytopenic patients?
Are you transfusing antigen negative units?  Are you transfusing randoms vs apheresis?  Do you collect from the mother for a directed transfusion?

Thanks!

We are probably going to go with pathogen reduction rather than test. If we do that we can rotate back to our supplier, otherwise we'd eat the cost of all unused units - which would be a pile of money.

Yup, no matter how we label them, we get a lot of platelets back in the cooler.  Again, we issue over 30 a day so there is bound to be some wasted, but this makes staff very frustrated.

We always combined just prior to issue.  No sense in complicating the nurse's life any more than necessary.  

That's my understanding.