SMILLER

We do not really need it here -- probably too many problems to deal with extra-departmentally anyway. In general, we can get uncrossed product to our ER or OR in an emergency situation within a few minutes. Scott

As of today, Saturday May 14th, we are looking at a looming blood shortage, here in Michigan and the US (for the reasons already outlined above). We had an unusually bad shortage in the US last January, but that will be nothing compared to this. We are currently considering lowering (again) transfusion thresholds, as well as coordinating with other facilities for the anticipated shortage of products. The problem here is that we are going to be in it for the long haul, and it is going to get much worse. Any efforts to encourage donation are going to be especially important during this time. Scott

We have been using a Logger-Trac Data logger which we have little trouble with. However, the software used for downloading records is called Maxithermal, and it only runs on Windows 7. Until they come up with a Windows 10 version, we have to maintain a PC that runs 7 just for this device. So what ever you choose, make sure you have a PC that the software will run on. I would recommend talking to other users once you pick a candidate. Scott

We have to have a current ABO/Rh, otherwise its going to be AB plasma. Patient ID is not 100% reliable as pointed out above. (If patient is arm banded and comes in later, that is a different situation.) Scott

It's a nursing thing, but I am pretty sure you cannot reconnect any kind of IV once its disconnected. Scott

Appreciate Kip's observations. above. Here our rationing policies involve cooperation between the four regional hospital systems along with the supplier that serves us. We have decreased transfusion thresholds for many types of patients--if a physician wants to override we are passing the request down the administrative line for approval when expedient. All hospitals are keeping inventories low voluntarily. If there is a real emergency at one of the hospitals the others will transfer stock as needed. Things are a bit better this week. Hope this is blowing over. Scott

In general, an MTP policy is set up between ER, OR and the Lab. Here it was the OR and ER physicians who decided what it should include. We started with an MTP partly directed by lab results, but found it unnecessarily cumbersome in practice. For our BB, an MTP includes setting up sets of blood products until the MTP is called off. If you search here with the word "massive" you will see a number of threads that may give you a few ideas. Scott

We are a smaller level 2 trauma center here. For example, we normally would want to keep our O pos inventory at 20. Today we ordered 15, they sent 2. This is the worst I've seen it in working 30 years here. Scott

Here in Michigan, we are now instituting rationing policies due to the severe shortage of available random donor blood. I was wondering how other North American facilities are doing. Scott

As a nursing task, the amount for each transfusion needs to be documented, if I am not mistaken. Scott

We only QC the antibody panels, both for pos and neg reactions, when they are being put into use--specifically to make sure they were not "damaged in transit". Scott

Our antibody-ID section in our procedure manual has gotten a bit bloated, but only because it is reasonably comprehensive. While we, like many, use the "3x3" rule, it becomes more involved when you start looking at individual antigens and antibody characteristics. (For example, a patient that is only producing anti-E is likely to start producing anti-c after they are transfused a few times. For this reason, most labs will screen units for anti-c for c-antigen negative patients producing anti-E.) Also, there are other considerations for certain situations, (such as a patient with a previously identified antibody need not have 3 positive cells to rule it in). In general, we have a procedure that details the 3x3 step by step. Then there are individual charts, tips, and notes for common specifics regarding certain situations, such as how to get around cold agglutinins, or the use of enzymes. You should be able to figure out what to put in your procedure from looking at the AABB manual. If your current procedure for antibody ID seems totally inadequate, you may want to start from scratch. Hope this helps. Antibody ID is the most robust procedure we have in our BB manual. Scott

And Happy Boxing Day! Scott

I believe the topic -- QC for panel cells -- has been discussed a few times here on Pathlabtalk. As far as "validation", not sure you need anything beyond what the manufacturer suggests. And I think Ortho only mentions QC. Scott

We check speeds and times quarterly, "calibration" (cell-button acceptability at different times) annually. Scott