[another "rule out" rule question: Solid Phase]

Our rules regardless of methodology:

K, rule out heterozygous

C, E, rule out heterozygous ONLY when Anti-D is also present.  If no Anti-D, rule out homozygous

[Sickle Cell Transfusion Patients]

Some of our city sickle clinics have closed so we have begun to see an increase in the number of sickle patients we are seeing.  A few of these patients are pregnant.  Some of our physicians are requesting phenotype matched red cell units, "because the patient is pregnant".  Many of these patients have been transfused for years as children with random units. 

What is your standard of practice regarding red cell transfusions?  Do you give full phenotype matched?  Do you give only C, E, K matched?  Do you stock up on their phenotype prior to the patient going into labor?

[Blood bank Samples]

6 ml

packed cells

Yes

[Competency Assessment Cry for Help! =)]

At my other job, one tech made the slides, but every tech was responsible for reading them and calculating results.

[Pre Transfusion H&H SOP]

We require related lab testing for any product to be done in house.  If it is an outpatient that will be coming back the next day, we use the testing performed the day the type and screen is done.  We have found that the testing done in the doctor's office if often significantly different than what we find.  We then have pathology speak to the ordering physician and we have had transfusions cancelled based on our in house test results.

[Another Interesting Article.]

Turns out our German patient needed irradiated blood products as he was a BM transplant patient.

[Another Interesting Article.]

We once received a letter that the patient said "was VERY important" if he ever needed transfusions.  We had to call our interpreter service because the letter was all in German

[OB Protocol]

Type and screen on all OB patients upon admission

[ABO/Rh and Platelet, Plasma Transfusions]

We require an ABO/Rh for each admission for platelets and plasma products.  If there is no history, our computer system automatically orders a confirmation type.

[Second ABO/Rh sample]

Our computer system looks for a history and will automatically order an ABO confirmation if a history is not found.  The only exception to this is pre-surgical patient because we know they are coming back and will be tested again day of surgery, thereby creating 2 different specimens.  Our system will also not allow an electronic crossmatch without 2 separate ABO/Rh results.

[Antibody ID Followup admissions]

We would do a selected cell panel on any follow up specimen, just to make sure there is nothing else there.  We do not reconfirm the previous antibody since you have to honor it regardless of its current reactivity.

[NPAR]

We have found it helpful to find historic antibodies that are no longer detectable.  We honor them no matter who ID'd them, thus preventing a potential delayed transfusion reaction.

[Antibody Screen]

We are going to change next week to doing "selected cell panels" on patients with previous antibodies.  I don't care if the antibody is still there, since we will honor it regardless of reactivity.  I just want to know if there is anything "new".  Why would I want to run an entire panel when I could do the same thing with 3 or 4 cells?

[NPAR]

The blood center that we use has an antibody registry.  Any hospital they service can enter patient antibodies found along with any other pertinent information regarding the workup.  When we receive an order in the BB, we always check our internal patient history and the blood center history.  It has been helpful many, many times.

[Supervisory staff on weekends]

Our laboratory supervisors currently work rotating weekends.  This is as a supervisor and not a bench tech.  We would like to gather some information from other facilities regarding supervisory practices.

 

1.  Do you have laboratory supervisors physically on-site 24/7 or do they take call on "off hours"?

2.  If they are on-site, is it as a supervisor or a working bench tech?

3.  If they are on call, is there a charge tech?  Are they compensated extra to be "in charge"?

4.  Do you have a supervisor for every department (micro, BB, chem, heme, phleb, etc.)?

5.  How big is your facility?

 

Thanks for your help.  I always get great feedback from all my lab friends here.

[RhIg Dispensing]

The different opinions from the pharmacies are very interesting.  At my last job, pharmacy insisted that it needed to come from them, since it is a drug.  I have tried to give it to them at my current position, but the BB med director will not let it go.

[Second ABO/Rh sample]

jlmoses - We just had to stick a patient for the third time because the nursing staff does not follow policy.  The first time they forgot to document the 2nd employee identifying the patient.  The second time both identifying employees failed to notice that the patient did not get armbanded.  Hopefully, the third time is a charm.  I would be very careful about relying strictly on following of policy for patient safety.

[QC on Panels]

B with parentheses makes a sunglasses smiley face. 

[pheresis platelet received in two attached bags]

When we pooled them together, we changed the date to 24 hours.  We also lost the ability to return them to the supplier if they ended up not getting transfused.

 

We no longer pool them together.

["Legal" release blood]

Thank you for all your responses.  I have convinced my pathologists that we need physician signatures for "out of the ordinary" blood products.  Now I have to revise our emergency request form.  Does anyone have a release form that they would be willing to share?

[Two separate sources of ABO/Rh antisera for electronic crossmatching blood types.]

We also use the same reagents.

If collected during the same admission, we do not allow the person who collected the original specimen to collect the second confirmation specimen.  This is to encourage positive patient identification instead of just saying, "I was just here, I know who you are".

[Returning FFP not used]

We just changed our policy to 60 minutes for non-red cell products.

[mislabeled BB specimen and bad outcome]

The lab is presenting an inservice to  nursing on patient identification and proper labeling of specimens.  We are looking for a real world example of a bad patient outcome due to a mislabeled blood bank specimen.  As much as I hope you all say it never happens, does anyone have an example of such an occurrence?

[What are your facilities procedures for indicating needing irradiated blood products?]

BM/PBSC transplant candidate or recipient

 

The nursing staff asks the patient at admission assessment.  If yes, a notification prints in the blood bank.  If ordered by a physician, we clarify the reason.

 

I once had an ER doc order CMVN Irradiated because he "didn't want his patient to get anything".  When I explained the real reason for the product, he changed his mind.

[Baby weak D and gel testing]

I received a call from a pathologist at a smaller hospital that uses gel technology.  They are a very basic lab that only does ABO/Rh and antibody screens, no IDs or other fancy testing.  Tube testing is their back up method.  Since they have not had any issues in several years, they are wanting to get rid of tube testing and just go with gel.  It has been several years since I worked with gel so I am coming to my experts (you guys) for help. 

 

Is gel sufficient to perform weak D testing on newborns of Rh negative mothers for the purposes of Rhogam eligibility?