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Always great advice from Malcolm I find the use of anti-A,B is helpful - especially when the red cells from cord blood react weakly with the anti-A (which we know can be underdeveloped). We accept weaker reactions in newborn samples than we do for adult blood samples. However, that being said, if there is any doubt - we will not report the ABO group (often the Rh is needed for RhIG requirements) and give group O blood if a transfusion is required. sandra

I think the intent of this "rule" was to not have the blood sitting around. The pre-transfusion checks should all be completed and the transfusion ready to be initiated as soon as the blood arrives. Now... in Canada we have a wonderful standard that states we can take the unit back if returned within 60 minutes. CBS did a lot of validation work to prove that there was no increased risk. Of course, we also require the unit to be transfused within 4 hours of issue. sandra CSTM 5.8.7.2 Blood components may be returned to the TS inventory if the following conditions have been met and documented: a. visual inspection of the blood component is acceptable b. the container is intact, including ports on bags c. at least one sealed segment of integral donor tubing is attached to red cell components. Alternately, an identified segment must be available to the transfusing site. d. the temperature of the blood component is acceptable as determined by one of the following: i. a suitable monitoring system indicates the unit(s) has stayed within the acceptable temperature ii. the unit(s) has been maintained in a container validated to maintain the appropriate temperature for the period that the unit was outside the TS iii. red cells, plasma and/or cryoprecipitate have not been out of the controlled environment for more than 60 minutes from the time of issue (per occurrence, not cumulative). e. The TS Medical Director may approve the acceptance into inventory of blood components that do not meet the requirements of this clause.

There was a study done here by ORBCoN in Ontario, Canada. It showed that most (I think it was 99%) babies were delivered from people under the age of 46. So yes, not all. But most. Best of luck on your journey to conceive. I had mine at 40. So I'm always tired, but love her to bits.

We are similar to those above - if a male or female over the age of 45 is using up all the Rh Neg stock we can switch them to Rh Pos. Earlier is better if they are a big bleed. We only require to alert the MRP it is happening. We also have no additional requirements/policies for switching back to Rh Neg once the bleeding has stopped.

Here is my old validation. Hope it helps Validation of the Electronic Crossmatch at the GGH - signed.pdf

I would love centralized temperature monitoring. Ideally, the whole hospital (i.e. pharmacy and what not) would be connected. How about electronic inventory management? RFID technology for the units? sandra

We do a screen and, if indicated, A and B cells. sandra

We didn't label the freezer drawers. But we do have a job aid hanging on the door with the freezer contents (by drawer). It makes it much easer if/when you move your contents around. sandra

We do similar to labguru. We went from manual tube to automated gel (BioRad) and have found the same thing. If we have a discrepancy we send it out for genotyping. Most come back as a weak D type 1 (or 2 or 3). I am considering doing a manual tube type on our females less than 45 when they type as Rh positive the first time. And then sending out any discrepancies for genotyping. sandra

Thank you for the feedback! We are pretty happy with the Bio-Rad cards and IH-500 as well. I'm still trying to figure out how to automate the antigen typing process with the QC available (needing a single dose for the positive QC) but feel like for our core lab staff using column agglutination for antigen testing has been widely preferred. sandra

In Canada, our standards also add a requirement to clearly labelled/segregated area: CSTM 3.2.1.7 Contamination of blood components or blood products from patient samples, reagents and/or tissue products shall be avoided by ensuring that blood components and blood products are stored in designated storage equipment or in clearly labelled segregated areas within the storage equipment. (See guidance statement below: Physical barriers are needed to prevent contamination of blood components and blood products from other materials stored in the same equipment or area. Examples of physical barriers include a leak-proof shelf or container (preferably with a lid), clearly labeled to reflect the contents. If the physical barrier is a shelf, blood components/products should be stored above any potential contaminants (reagents, patient samples, etc.).) sandra

We do the same using the same reagents (but called Bio-Rad) and the SAXO (similar to the Banjo, i think). Our reagents are all scanned into the IH-Com when using the SAXO reader - as long as the IH-500 uses the same reagents the QC flag is absent. sandra

We use an IH-500. If the reactions in the software have no discrepancies (from previous or within the current results, weak reactions, error codes, etc.) they will autovalidate to our LIS. Our LIS does not autoverify. Those are always looked at before being released. sandra

Wow, reading the challenges my American colleagues are having! I thought it was bad here in Ontario, Canada. The hospital laboratories here generally pay the same - unionized or non. And we don't generally have any sign on bonuses outside of working in the North, although I have been hearing some nursing/physician incentives. And I don't think I have ever heard of travelers here. We are starting to get creative with scheduling (looking at 12 hour shift models) and using more lab assistants to do work that does not require the MLT (or lab scientist in the US). Even in the blood bank. People are tired and burnt out.