TIrwin

When you say the first antibody screen is "unofficial", does that mean you don't report the result to the patient's chart? I would definitely want that result to be documented on the chart so nobody can claim they didn't know there would be a problem.

Do you have a reference for that? It didn't come up at all during our last FDA inspection, which was otherwise quite thorough.

Both the patient and the control reacted out to a dilution of 1:32.

I don't think the history is very convincing. He has neuropathy and an elevated CK, but he also has diabetes and hypertension. I was told he had acanthocytes, but when I looked at the smear, it took me a while to find anything I'd even consider calling an acanthocyte, and it certainly wasn't a textbook appearance. Titration is not a bad idea though; we might try that anyway. Unsurprisingly he typed as K-k+ and we so rarely use our anti-k antisera that I wouldn't feel too guilty about using some more.

We have the HemoSafe in our OR area as well as three BloodSafe controlled small refrigerators with kiosks and magentic locks distributed throughout our facility for massive transfusions. We are very happy with their performance. A word about the "coolers as storage" idea: When we had our AABB assessment in 2009, the assessors threw that at us as well. I knew it sounded wrong, (not to mention the fact that our assessment was prior to the effective date of that standard) but at the audioconference for the changes, which unfortunately didn't take place until a few weeks later, Debbie Kessler made it very clear that blood sent to the OR in coolers is "transport", not "storage", as long as the time period doesn't exceed what the cooler is validated for. She said "the cooler is transporting blood out to the OR and back to the transfusion service with a pause in the OR". I made very detailed notes about this so that we could respond to the variance. That said, I would still recommend the HemoSafe if your budget allows. You are able to maintain tighter control over your inventory and keep detailed logs about their disposition.

Ironically, (or maybe not ironically) I got a request from one of our hematologists last week to test his patient for the McLeod phenotype.

With our current paper system, the nurse is required to document on the transfusion record that the consent and order to transfuse have been verified. We have had instances where one or the other were not present and the patient was transfused. We are in the middle of implementing an EMR system where the release/dispense slip and the nursing flowchart are generated from the physician's order to transfuse, so we can at least be sure that there is an order. Consents will still be on paper, however, so we are requiring that the nurse verify consent and document that in their flowsheet. I would be adamant about the blood bank not taking responsibility for items in the patient chart when the blood bank staff does not have access to it.

The paper describing the results of the Passport study were published in Transfusion in March 2010, page 589. [ATTACH]454[/ATTACH] I don't remember where I downloaded this document describing why it was discontinued, probably from www.passportstudy.com, but that site appears to be defunct now. PASSPORT Discontinuation.pdf