SMILLER

Agree with Ward's points, above. Any change in policy will involve discussion with ER, Surgery, etc. that includes education once a decision is made. When we became a level 2 truma center a few years ago, we had a rather elaborate MTP process that included things like Coag and CBC results. We have two different orders for emergent situations: An "Initial Resusitation Cooler" order (2 RBCs, 2FFP), and an "MTP Protocol" order (5 RBCs, 5 FFPs, 1 5-pk platelets). We repeat the MTP order until it is called off. In addition, individual orders for uncross matched products can also be made. Scott

Here we have to positively ID a patient for each admission. This involves arm banding and at least an ABO/Rh for plasma or platelets. Scott

I would think that the rephrasing was to emphasize that is is the reagent in the vials (not just the vials themselves!) that expires after 7 days. I think it is clear that they are saying they claim the reagent is stable for 7 days after opening. If I were an inspector, I would interpret the new phrase as indicating that the "performance characteristics" end after being "maintained" for 7 days, which would mean that you cannot use a vial after that time. Scott

A policy that concerns massive transfusion situations (where a patient with an unknown ABO may have to be switched from AB to A plasma) would fit here I think. For the other, our blood supplier does not send out plasma from donors with atypical antibodies---I think that is common practice. Scott

We have been doing open heart surgeries for decades and do not miss having a TEG or Rotem. (From what I understand, they are more sought after for trauma surgeries.) For BB products to be held available, you may have to have platelets on hand. Here, many OH patients end up having 2 units of RBCs on hold (or sent to OR in a cooler). Cell savers are maintained by Surgery here. Almost all of these issues should be determined by your cardiac surgery department--it is unlikely that you will have to make a decision one way or another for deciding on these types of services. I would think that rather your job will be the Lab side implementation once decisions are made. Scott Scott

This may not be exactly what you are looking for, but it is instructive for basic step-by-step procedures for antibody ID. https://camlt.org/wp-content/uploads/2017/09/Advanced-ABID-Case-Studies-CAMLT.pdf

We do not use outer bags. Scott

All 'it is written's should be the property of each individual facility, approved by your medical director or pathologist. Here is one discussion regarding drawing blood specimens and transfusions: https://www.phlebotomy.com/pt-stat/stat0513.html There are also old threads here in Pathlabtalk on this topic. Scott

Ya. If I recall correctly, this patient had a strong 1+ reaction with all C pos cells, except for that one screening cell. That one screening cell otherwise reacted normally with anti-C from both reagent and another patient. So just have to forget about this one. Scott

Some important stuff here, too... https://www.youtube.com/watch?v=1VKt2LysGxA

Not being familiar with HFAP, I would wonder why they do not inspect Blood Bank along with the rest of the Lab? Scott

Yes. At least we got a reaction with anti-C reagent. Likewise, that particular cell reacted with another patient who was producing ant-C. Scott

The patient is long gone. But the same method -- manual gel -- was used for both the screening cells and the panel cells. As I mentioned, the reagent cells were both all R1R1 (but from different donors)--yet only the cells from the one screening set was negative. Had to be something wrong with that particular cell and that particular patient. Scott

It seems like you are suggesting that CAP inspect your lab for all departments except BB, which you would have done by AABB? Is this even possible? Can you be selective about what CAP looks at? Under CLIA, regulations for all areas in the Lab are pretty stringent, whether AABB, CAP, JCAHO or FDA. If you want the extras ('prestige'?) that come with paying the AABB for another inspection, then I guess it's worth it. Scott

Agree with the comment above. While the patient is in your chopper with your blood, it's your patient. Somehow you must be be charging for the ride and any other care in flight. And like any unit transferred with a patient to another facility, you will have to follow up to finish the transfusion record. Scott

You almost got it. But I think the original question here was about using gel diluent with QC materials to create positive and negative control cells. Scott

I am not explaining myself well. Perhaps it may be hard to understand unless you have used such a system. In a transfusion service, like a hospital, the BB armband number (regardless of the name or other information on the label) is placed on the specimen when it is drawn. That number goes into the BB computer system when the type and screen and other testing is done. If a product is ordered, that BB number is on the tag on the unit. When it is issued from the blood bank, that number must be on the request form brought to the BB--otherwise no issue no matter what information matches up. (Of course, name, birthdate, etc. must match also.) When the unit reaches the patient, the BB number on the unit tag must match the BB number on the BB armband which is on the patient. Its a full-circle kinda thing. The unit is very unlikely going to go to the wrong patient--no matter how they are otherwise ID'd--if a strict BB number and armband system is used. With such a system, which is relatively common I think, the patient can come in and be under a false ID, and still get appropriately matched blood products. One cannot say this for a system that only depends on two separate draws for assurance that an electronic XM is appropriate. If the wrong patient is drawn once for some reason resulting in WBIT (like in the wrong bed in a room)--the same circumstances can cause the second draw to be WBIT. Then if the unit goes to another patient---well, that's when the God Help us comes in! Scott

Right, but I am sure that you do not antigen type all patients and give them antigen negative units as appropriate for those antigens! Scott

Except that the QC manufacturer's diluent used to make a control antibody solutions is not used in any phase of patient testing--it does not need the be QC'd--it is QC. I would think the point is that the gel diluent is being controlled (which it should be), by showing it does not produce a positive reaction as a negative control. When patient or unit cells are being tested in gel, you use that gel diluent to create an 0.8% suspension--so for a positive gel control, if you are creating your own 0.8% suspension, again you want to use the manufacturer's diluent. Scott

With a BB armband system, the blood drawn at the time the armband is applied is going to have the same BB ID as the unit being transfused. Even if the patient is initially registered mistakenly with another persons ID, they will be getting safe transfusions as long as the BB armbanding system is used appropriately. (In such a case, no matter how many draws you do for the ABO/Rh, they will all be wrong for that registered name--but at least the transfusions would be safe for the mystery patient.) Scott

This goes back to some comments made earlier in this thread. It is impractical to screen for all antigens for a particular patient that may induce an antibody response. However, for a patient that is actively producing (or is known to have produced) an antibody for a particular antigen, transfusing known antigen positive blood would clearly not be indicated if it can be avoided. Scott

I would think that you can define "properly delineated" for that particular cell washer however you like--as you have the manufacturer's input on what it is going to look like. As for fill volumes, we have a Ultra cell washer (not a CW II though). If it fills to 80% of the tubes and all tubes are within 1 cm of each other, then we say it is good. Scott

That observation makes a lot of sense to me. Also, I think that the comment noted above by StevenB, regarding the unusually lukewarm AABB position, is telling. If the AABB is not going to take a hard stance on the issue, then routinely screening for little c in these cases seems to not be indicated under most clinical situations -- and certainly not required by any regulatory standard. (As for my lab, it wasn't that long ago when we were still screening for e negative units for patients making anti-C!) Scott

I just read what I posted yesterday and would like to officially submit that post for longest sentence of the month. Scott

Except that if you know the patient has been transfused in the past, and now has anti-E, and you also know they are c antigen negative, it would be nice if you could avoid having them produce anti-c. You already would know that they are a responder, and for future transfusions (for, say, a chemo patient), it would be nice if you did not have to screen units for little c. (Extended phenotyping of patients to avoid transfusing certain types of blood is indeed done for certain cases, such as Dara or sickle-cell patients.) Scott