[BloodBankTalk: Blood Transfusion Therapy in Haemoglobinopathies]

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[BloodBankTalk: Allergic Reaction]

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[BloodBankTalk: Antibody/Antigen Reaction]

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[Anticoagulant in Frozen Plasma affecting INR reversal?]

We have had this discussion.  If you are transfusing to a number, you need to remember that the transfused plasma also has an INR value.

[2rd determination of recipient's ABO]

We require the second specimen to be collected by a different person.

[Nurse Collections for Blood Bank]

Our phlebotomist are trained to never accept a tube and/or put their ID on it if they did not witness the draw.  If we determine that has happened, there will be discipline for not following policy.  They are very good about ratting out the nurses who try to get them to do that.

[Tracking Transfusion Orders]

We keep our transfusion orders in a binder and place a unit number sticker on the paper when we issue a unit.  When the patient is discharged or the specimen expires, the order is removed from the binder.

When we went to electronic issue, we were able to decrease our routine inventory significantly because we no longer moved units back and forth from XM to available to XM to available.  We are still working to teach the physicians not to order products until they actually need to transfuse.  However, we did get the "keep ahead" order removed from the order set.  Baby steps

[CAP Alternative Assessments-Help!]

CAP has an RBC Antigen Typing proficiency available.  It comes twice a year.

[2rd determination of recipient's ABO]

Type O

[COOLER FOR THE OR]

We just got some from MaxQ.  They are corrugated plastic and we validated them for 12 hours.  They have a handle on both sides for easier carrying and the ORs love them.  They are bright yellow so they (hopefully) will not get left behind in the OR or discarded as trash.

[Frequency of T&S for inpatient antenatal patients]

We do as Baby Banker does, create a selected cell panel to rule out everything else.  The game we play is how few cells can we run and have a valid rule out panel   We have had several patients that we do every 3 days until delivery.  One of our patients had Anti-c and Anti-E.

[Issuing blood in Cerner with e-XM]

The "issued by" is captured at the time of issue by who is logged on and performing the task.  We scan employee badges to capture the "issued to" employee.  We do not assign/XM/dispense anything until the courier is at the window to pick it up. Cerner does that for you when you use computer issue.  (Unless it is a RBC for patient with an antibody, then full XM ahead of issue) 

[Extending specimens past 3 days]

About half of our surgery patients are first timers to the blood bank.  Since we need two independent types, we use the pre admit type and screen as the first type and a heads up for any antibodies.  They always get redrawn the day of surgery for the type and screen we will crossmatch with.  That may be 28 days later or the next day.  We then have 2 independent types for our ABO/Rh confirmation.  We do not extend sample dates past 3 days without a really, really good reason and pathology approval.

[Misidentification risk mitigation alternatives]

If we do not have 2 separate types, the patient gets O until we do.

[MRN vs FIN]

What identifiers do you use besides patient name?  Medical record number, date of birth, financial/encounter/visit account number?  What do you use to look up patient BB history?

[Repeat Testing for FFP and Plts]

We use encounter (visit) for platelets and plasma.  If they go home in the morning and come back in the evening, that is a new encounter, so a new blood type.  We do not require a screen for plasma products.  We do have lots of oncology patients that get a recurring encounter that is good for 30 days.  After that 30 days we do another type.  Red cell products require every 3 days or new encounter, whichever comes first.

[Weak D+ specimens]

We are adding weak D testing to our automation menu and are attempting our validations.  We have plenty of weak D negative specimens to run, but no weak D positive specimens.  I contacted our blood supplier, but they send their specimen processing out, so they no longer have samples to share with us.  Does anyone no of a way to manufacture a weak D positive cell?  Or any other suggestions where we might be able to obtain some for our validation.

[Freezer Problem]

When ice builds up in our freezer, the defrost temp tends to peak much higher, sometimes out of range.  If we let that go on too long, the freezer dies completely.  After we do a manual defrost, the defrost temp stays much lower.  So I think your maintenance guys are right that it only needs a small defrost range.

[Wireless temperature monitoring and alarm checks]

For those of you using a wireless temperature monitoring system, how often do you perform alarm checks?  Does the manufacturer of your system have a recommendation?  Who performs the alarm check (blood bank, biomed, plant ops, ??)?

[Blood Product Check on Nursing Unit]

Our policy states one must be the transfusionist (RN) and the other must be "a qualified individual".  There must be documentation that they have been trained to do the bedside check to be considered "qualified".

[Combine or not?]

Nurses combine at bedside.

[Blood Bank Manager]

Our computer system has RhIg built as "not clinically significant" and will let us electronic crossmatch.

[Antigen typing on recently transfused patient]

We don't antigen type recently transfused patients.

[Retantion of Archived SOPs]

Reference Std 6.2C  Item No. 33

Identification and appropriate archival of obsolete documents - 5 years

[Draw and Band charges]

We just did a study to track "extra" tubes from just the ED and discovered that only 0.01% of those tubes are ever used.  We now no longer keep track of any extra tubes that may be sent.