pbaker

The IS crossmatch does not confirm the ABO/Rh of the unit. That only tells you that it is compatible with your patient.

The state of Illinois mandates an OB Hemorrhage protocol. Our hospital is still working on an actual "massive transfusion protocol".

Do you still perform IP therapeutic phlebotomies? We are phasing out our OP service, but still have 1 or 2 IP requests per year. The blood bank currently performs those, but I am really concerned about competency with that few. Just wondering who does those in other facilities?

Our system automatically cancels them, as well. The phlebotomy team does not even receive an order to draw.

The guidelines on our transfusion order form state: "If fibrinogen is less than 100, give 10 units. If fibrinogen is less than 50, give 20 units." We only stock pooled cryo (1 pool = 5 units)

Does anyone remember an article discussing how much money was saved when extra tubes were no longer collected? Our blood bank routinely has 10-15 extra tubes per day with a miniscule amount actually being used. I'm sure the core lab has even more. Sometimes the same patient has an extra tube multiple days in a row (No wonder we have to transfuse patients!!!) We are thinking of performing a cost saving study but vaguely remember one already being done.

We issue about 3500 red cells per year. We also have Swiss Log, but use no padding

We have been issuing blood by pneumatic tube for over 2 years and have had 1 unit break. Since we send everything in a sealed ziplock bag, it was all contained and no decontamination of the system was required.

We do not thaw anything until they submit a request for delivery, meaning they are ready to actually transfuse and then thaw group specific. We waste very little.

For those of you that use per diem techs in your labs, how is their schedule determined? Do they submit their availability and you plug them in then? Or do you find out what you need for scheduling and contact them to see if they are available? If they say No continuously, do you keep them on staff? Our per diem techs are currently sort of driving everyone else's (FT & PT techs) schedule because of their limited availability. It seems we are catering to them instead of the others and we are trying to improve the scheduling process. Like most folks in the lab industry, we are trying to do more with less.

We have recently had a rash of folks making it all the way to the OR with no blood bank testing (ex. a splenectomy with a 65 platelet count!!!) We insist that 2 specimens be collected at different times. Unfortunately, it is our phlebotomy team that has to gown up and go into the OR. We will accept a fingerstick specimen for the confirmation typing.

We only ask the questions of those folks that have had pretesting performed prior to surgery. (we also ask about pregnancy) If all was negative on pretest day and the answer to the questions is NO, then all we perform on day of surgery is an ABO/RH and use the antibody results from the pretest specimen. We have had several training sessions with our surgery area reminding them of the utmost importance of correct answers to the questions.

Our work around. If the patient has a blood type history that came across in the conversion, we perform an "ABO verification" by retesting the same specimen. This allows Meditech to think there are 2 specimens and allow electronic crossmatches. This is a different test than our "ABO confirmation" which is performed on a completely different specimen when a patient has no previous history. For the uncrossmatched units, it only makes you do IS XM on those units issued prior to specimen collection/completion. Once all the necessary testing is done, you can perform EXM.

If the antigen testing is actually performed by the blood center, we do NOT repeat the testing. They mostly send us "historically" typed units which we then reconfirm at our institution.

Just because they present with a valid ID, does not mean that registration will type the name correctly!!

We also have a form and/or computer generated order completed by the physician. No order, no blood (except OR)

We have an e-mail distribution list for duplicate medical record number issues. I get at least 2 or 3 notices per day and keep them all in a three ring binder. If there is no blood bank history for either number, then I just let registration take care of it however they take care of those things. If there is a blood bank history on one of the numbers, I send a specific e-mail stating that this patients records MUST be merged into one. Unfortunately, they will not do so until the patient has been discharged from their current stay. If there is a clinically significant history on one number, I add it to the other number with a comment. (We also have Meditech) But like R1R2 says, you can only deal with the information you are given.

AABB Std 5.13.3.2 talks about needing a specimen within 3 days of transfusion IF pregnant or transfused within the previous 3 months, or if history is unclear or unobtainable. We use the results from the pretesting up to 30 days out and collect a new specimen for ABO/Rh day of surgery. If blood is needed, we crossmatch using the new specimen and the old antibody screen results. Again, we only do so if no transfusions or pregnancies in 3 months.

Wondering what everyone's policy is on automatically doing a DAT on cord blood. Our current policy is DAT on all babies of Group O and/or Rh negative moms.

We use the badge secure option to send blood. BB staff must scan their badge to send the product and nursing staff has to scan their badge for it to drop into the tube station. That way I can track who sent it and who removed it from the tube system. If it isn't removed in 5 minutes, it automatically returns to the blood bank.

I interpret that to be red cell transfusions.

We use Immucor and have not had any problems with our standing order. It does help if you let the check cells sit a few minutes before you read them. They tend to be stronger.

All of our blood products are leuko-reduced. We give CMV seronegative to BM/SC transplant patients until we know their CMV status. If they are CMV +, they no longer get tested units. We don't usually transfuse neonates (we transfer them out), but if we ever had to, we would get CMV seronegative from the blood center (if the physician can wait) If we get an order from the physician, we do question it. We have found many physicians don't have a clue as to why to give CMVN products. I had an ER physician order CMVN/Irradiated for his patient. When I explained which patients truly need those products, he said never mind. He was just trying to prevent the patient from "getting anything".

I should clarify my question. If this is a new admission 6 months later, would you get a new specimen? (Thanks goodchild for making me think of that clarification)

Here is an ongoing question regarding panel cell QC. If you QC your expired panels cells, do you QC your in date panel cells? For those of you that use Anti-Fy, what if the antibody you are trying to ID is not a Fy? To be truly accurate with QC, would you not need to test every cell for every antigen listed? Haven't we all found examples of antibodies that haven't read the book and do not react with all the cells they are supposed to? Is it because of the antibody or because of the cell? Would QC help in this situation? Just playing devil's advocate