Gnapplec

Does anyone have a good software for flowcharts, or do most of you just use Excel for that?

The trend at least in NY State is to have only MTs in the Blood Bank because we do high complexity testing.  However, in my years of experience, I've had MLTs that were great Blood Bankers and MTs that are terrible at it so it really depends if someone has critical thinking skills and attention to detail or not.

Change things as in?
From my experience, a persons understanding, willing to learn, and pro-activeness is dependent on the person and not whether they are a MLT or MT.

Well, that's me finished.  I am officially retired from work - but not from this wonderful site!

In order to have a 7 day platelet, it has to be tested on the day of transfusion, so I would think that it would be difficult for blood suppliers to manage that process.

We are not looking into this because I believe in order to extend the shelf life of platelets to 7 days you have to be a registered/licensed facility with the FDA.  We transfer our short date platelets to our Trauma hospital who has a better chance of being able to use them before they expire.

My condolences on losing your Medical Director.  Only rarely have I come across one who was very conversant with the ins/outs of Transfusion Medicine, particularly the serological aspects of advanced blood banking.  They are out there.  I have recently taken over as an interim manager for a 3 hospital group.  We have 6 pathologists.  Between them they have a very good understanding of transfusion medicine.  They rely on my technical expertise in the serology that we perform and the advanced testing I expect to be bringing to their table.  My docs all take call but they appreciate that now I field the majority of questions - only sending them the Medical decisions.  (I told them that I am not averse to making one of those calls in a very urgent situation but that they would definitely have the final say).  I hope your facility takes its time or really performs as aggressive search for someone well-versed in the field.  I have worked in large, tertiary care places where they tell the residents (and sometimes the on call MDs) do what the BB tech tells you.
Good luck
 

The HemaTrax  "Stand-Alone" system can generate all ISBT128 compliant labels from blank stock during down time and emergency release circumstances if you wish to have an on-demand system.

I am going to be REALLY unpopular here, but I'm going to say it anyway (because I am a pedant)!!!!!!!!!!!
 
Antigens CANNOT be either heterozygous or homozygous; only genes can be heterozygous or homozygous.
 
An antigen can be described as either showing homozygous expression, or heterozygous expression.
 
That having been said, is a red cell sample that types as K+k- phenotypically, genotypically K/K or K/Ko, or even K/k, with a mutation within the Kell gene that prevents the k antigen being expressed and detected with all anti-k grouping reagents (just in case anyone doesn't believe me - we had one!).
 
That's got that off my chest.
 
Now then, there is NO doubt that there are some anti-K's around that only react with K+k- red cells (dosage), but they are fairly rare, however, how many people use antibody screening red cells that are K+k-?  I doubt if there are any.  Therefore, we are all ruling out anti-K using red cells with apparent K antigen heterozygous expression on every single sample that (apparently) has no atypical alloantibodies present.  Am I wrong about this?
 
It follows, therefore, that, over the years, there MUST have been occasions when a patient with a very weak anti-K (one that is only detected using red cells that are apparently showing homozygous expression) and who has been transfused with K+ blood (do the maths).  As far as I know, there are no papers within the literature that report a case of either a delayed or an acute transfusion reaction as a result of this.  Yes, this may cause the anti-K to become stronger (and, hence, be detectable using an apparent heterozygous red cell sample showing K+k+ expression), but then, if this happens, you give K- blood.
 
So, my considered answer is that you can exclude using K+k+ red cells.
 
I shall now go and lie down!!!!!!!!!!!!!

I used to work at one of the above mentioned reference labs. When I started about 25 years ago,  they were using pooled cells on prenatals. We agreed that was not an acceptable practice even then & changed to the two cell screens.  We sometimes did 300 screens a day in tubes so that was a huge increase in workload. Before I left, we had migrated to two cell screens on an instrument. 

I say change your SOP to match your practice, as long as it has been validated, passes daily QC and doesn't contradict manufacturers requirements.  I don't know of any transfusion services that wash the cell suspensions routinely anymore.

Coming from a reference lab perspective, we couldn't do our job if we didn't use some expired reagents.  We have 2 LN2 tanks that hold our library of rare cells.  It has taken our lab over 40 years to accumulate these resources.  In some cases, our cells are from the propositus the antibody/antigen was named after and the donor is no longer alive.  You can't get most of these cells commercially.
In some instances, it appears that regulating groups try to control something just for the sake of control.  Control of a service/technique doesn't necessarily make it better quality, it just makes it more expensive or prohibitive to provide.  Immunohematology isn't like chemistry, hematology, urinalysis, etc.  It's not as easy to put this part of the lab in a box.  At least, that's my opinion.
And there is no such thing as a "mere generalist".  There is much to keep track of when you are working in several different departments; that's no "mere" feat.

Sometimes I think that the "regulators" feel obliged to fix problems that don't exist. Does anyone recall a rash of patient morbidity/mortality due to the use of expired reagents in the blood bank arena?
That being said, the use of such material should be restricted to those with the appropriate knowledge and expertise.

We use one homozygous or if absolutely necessary two heterozygous to rule out. Then 3 positives and 3 negatives reacting as expected to rule in.
Of course you always have to look at the whole picture and use your brainpower to see if you can figure anything out when things are not clear cut. Which seems to be happening more and more often these days!

Marvellous, isn't it, how other people who have no idea about how to run a blood bank (and probably don't know what it does, or even where it is) know more about how the documentation should be written, etc, than do the people who have been doing it for years.  Of course, this very rarely happens, does it!!!!!!!!!!!!!!!!!!!!!!!!!

How many more babies with clinically significant haemolytic disease have you discovered with your more expanded testing (i.e.every baby), as compared with your more restrictive testing, and, perhaps more to the point, how many more (if any) that were not recognisable by overt symptoms?

It would be interesting to hear exactly why the new paediatrician wants to go back to this testing regime, considering that it has been known for decades that the DAT in a case of ABO HDN can be negative for a couple of days from birth, and only then become positive.  May I respectfully suggest that this new paediatrician relies on his or her ability to look at the baby's symptoms, rather than his or her ability to read laboratory results.  This way, more babies may survive.

I thoroughly agree with everything Terri has posted here, but would, also, re-quote some very wise words from Dr. Brian McClelland MD ChB ND Linden FRCP(E) FRCPath, a now retired Consultant Haematologist of the Scottish National Blood Transfusion Service (with a world-wide reputation) that are,
 
"Transfusion has risks, but bleeding to death is fatal."

Just because the nursing staff doesn't want to do something is absolutely no excuse for compromising patient safety.  You need physician involvement here, the pathologist, director of ED, someone with MD behind their name.  
 
You can quote Blood Bank regs all you want and they won't listen.  Don't try and fight this battle yourself.  Turn it over to your risk manager (hope that person is not an RN!)

Recognize that you will reach a point where the phrase; "the cost of doing business" will have significant meaning to you. One of my biggest black holes for blood waste was NICU. We had done everything possible to reduce the waste but we finally reached a point where administration and physicians had to come together and understand that if they wanted an NICU and the service they expected then they would have to accept a certain level of waste. That does not mean we stopped looking but there comes a time when you just have to say, "this is all we can do and maintain the level of care/service you desire".
Administrations love to say that everyone must cutback but there will be no loss in service, quality, patient care or any thing else. There comes a point this is not possible but they will never admit that. Good luck in your quest and may god have mercy on our souls!
:lonely: If you can't tell I just got back from 10 days of sick leave and not feeling terribly chipper at the moment.

That made me burst out laughing. In America that would be a very vulgar statement indeed !

Sounds a bit dodgy to me!!!!!!!!!!!!!!!!

At our hospital, we don't call these units "least incompatible", they are labelled as "best matched" units. The physician / treating consultant usually refers such cases to a hematologist. Usually they try to put off transfusion as long as possible, but if imminent, one of them must sign a consent for release of such a unit. If they order a next unit then another consent is again taken, just so that the treating physician is in the loop, lest a nurse make a mistake and order for next unit to be released for transfusion based on the previous hb record.

Like Trish, although my staff may be on-call, they all know (and do, I am glad to say) telephone either me or my fantastic deputy, Doris Lam, at ANY time, day or night, and they are NOT generalists - in fact they are all red cell immunohematology experts - we all need a hand some time.

Wow Malcolm, who needs reference books?