[CAP ALL COMMON CHECKLIST COM.04250]

The checklist says "If the laboratory uses more than one nonwaived instrument/method to test for a given analyte, the instruments/methods are checked against each other at least twice a year for comparability of results".  I had interpreted this requirement applies to routine blood group and Rh test and antibody screen only.  It should not apply to antibody identification methodologies because different methodologies can be used to identify the antibody depending on the characteristics of the specific antibody.  But now there is opinion saying that this also applies to the antibody identification testing.  Please share your thoughts on this, particularly if you are t CAP inspector.  Thanks.

[Neonatal Exchange Transfusion]

I just have aquestion how fresh the RBC should be used for neonatal exchange transfusion? is there any reference standard for this? In our institution we use RBC less than 7 days old. Thanks.

[Warm Pack to use for transport of sample for cold agglutinin screen]

I would like to know what type of warm pack/container do your facility use for keeping the sample "warm" during the transport to the lab for cold agglutinin screen? Our facility uses the "baby heel warmer pack" to wrap around the sample. If they cannot found the baby heel warmer then they will keep the sample in a cup of warm water and deliver the sample to the lab "stat". Is this acceptable? Thanks.

[Baby born to a mother with SCD requires Hgb S Negative RBC donor unit for top-up transfusion?]

A question from one of my staff technolosits:"  If a baby is born to a Sickle mom, should we be testing for Sickledex on the unit we are transfusing to the baby even when we don't know if the baby is Sickle or not?"   Our current policy is that Hemoglobulin S Negative Red Cells will be provided by neonatal exchange transfusion but not for regular top-up transfusion unless the neonate is diagnosed with SCD.

 

I would appreciate if you can share your current practice in your institution.  Thanks.

[Antibodies Identified at Another Facility]

Same as others. We register the antibody to the patient's reocrd in our LIS system. Our LIS system will differentiate between the antibody identified from other healthcare facility or actually from the antibody workup in our lab.

[blood adminsgtration filter for neonatal transfusion]

I would like to know what size of filter should be used for adminstration of red blood cells to neonatal patient? Currently our NICU ward is still routinely using 40 micron filter for rbc and 80 micron fileter for platelets. Thank you for your input in advance.

[CAP - TRM. 44970 Radiation Dose (...Quality Control Program for the indicator system)]

We just recently had a CAP inspection and were cited for non compliance for this checklist. Specifically the inspector cited that we did not QC the new lot of the irradiation indicators when received? How do you perform the QC? Any suggestion will be appreciated. Furthermore, if you can share your Quality Control Program for the indicator system will also be appreciated. Thanks.

[validation of Optiseal tube sealer]

We just purchased a tube sealer from Baxter. Will appreciate if anyone can share the validation protocol and form for validation. Thanks.

[Kliehauer-Betke or Fetal Bleed screen when infant is weak D (by testing)]

Is anyone calculating FMH by Kleihauer-Betke when the mother is RhD neg and infant is weak D? Since with regular testing we cannot determine if infant is weak or partial D we treat all those tested as weak D as if they could cause immunization. However in package insert for Fetalscreen test (using rosette method) it says that the screen may be falsely negative if the infant is weak D. Should we then require that a Kleihauer test be done in these cases? Of course we all hate the K-B in our chronically understaffed BB. Could the weak D infant cause the mother to need more than one vial of Rhogam even with a bleed of more than 30 mL?

We will perform Weak D testing on the baby's cord sample if the immediate spin D typing is negative or very weak. If the baby is weak D test posiitve, we will interpret the baby is Rh Positive and perform BK test for the Rh neg mother and skip the fetal screen test.

[Trm.31450]

Well done. I totally agreed what Suszane Butch's comment about the methods comparsion especially for antibody identifcation methodologies. I think this checklist will make sense for instruments. In our hospital, we have two instruments (Galileo for routine samples and Echo mainly for stat samples). If one is down, then all samples run in the other one. It is important to ensure that it does not matter which instrument to use, the result is the same. I think the comparsion studies will ensure this.

[Trm.31450]

I interpret this checklist only applies to the following tests: Blood group and Rh typing, antibody screen, DAT , phenotyping test between different methodologies and it does not apply to the different tests used for antibody investigation because different situations will dedicate which method to be used. Please comment.