SMILLER

Once a day, along with other daily reagent QC, we incubate at 37C for 15 minutes our anti-D reagent with D-negative QC cells. We wash 3 times and test with anti-IgG. Then check with Coombs control cells. This simulates what we do with a tube screen. If the reactions are negative and positive respectively, we say that that validates "QC" for the cell-washer. JCAHO has not had a problem with this. Scott

We do see cold anti-Ms (or colds that mimic anti-M) causing trouble with gel often enough -- they have to be resolved in tube, often with the pre-warming, We are unlikely to do any further testing to identify what kind of cold antibody this is. Its just unusual to get a patient with a strong cold agglutinin that does not interfere with our manual gel screen testing. We are not complaining! The patient has been transfused a few times with no problems. Scott

Reverse O cells are negative with this patient's plasma. I should also note that the (tube) poly DAT was about a 1 or 2+, with a negative anti-IgG. We don't do anti-compliment testing. Scott

We have performed two T&S s on a 79 year-old male who is in for a GI bleed. He is on record as a A pos with no previous difficulties in testing. But for both times we have done and ABO/Rh, his reverse A1 cells are giving a 2 or 3+ reaction (in tube). Not due to rouleaux. We have to run a 60 minute, 37C settle test in order to get a negative reaction. He is positive with anti-A1 lectin. His CBCs have to be warmed in order to get a good RBC. Cold agglutinin? But the gel screen comes out negative - no interference. That seems curious for what is almost certainly a cold agglutinin. Just wondered what is going on here. IgM antibody to a miscellaneous antigen? Scott

The problem is not just that the unit is or is not within particular temperature range before being put back into use, but rather the unit has not been monitored while not in the care of the blood bank. A unit sent to, say. OR in a cooler, may have been "checked" when it got into the theater -- and left for a time on the counter (maybe next to an incubator!) -- returned in the cooler on ice you will never know if it was kept at a proper temp all that time. And how do you really "validate" a unit's potential for a "detrimental" effect? Transfuse various units left on a counter for different times and see which patients have a bad outcome? Scott

Drugs?

Right, and I would not even go so far as to say that a CAP or JCAHO inspection is equivalent (as far as how stringent it is) compared to an AABB injspection. Just that any CLIA accredited agencies are going to be using standards that are derived from AABB guidelines. In fact, the FDA does some extra stuff beyond AABB for things like tissue tracking. Scott

In the US, all accrediting agencies must satisfy CLIA, and Blood Bank regs are based on AABB standards. So AABB standards are already in use by JCAHO, CAP, etc. Scott

If one is doing a DAT in order to determine the status of a possible acute transfusion reaction, then the presence of antibodies on donor cells is the concern. There may be some use in incubation here to enhance uptake, but I have never heard of it being part of anyone's transfusion work-up procedure. Scott

We haven't for some time. It always was a crappy test for so many reasons. For general platelet function, we have a PFA-100 , and for P2Y12 (e.g. Plavix) and aspirin, we use a Verify Now (Accriva). Scott

The patient who currently needs the screening done gets charged for however many antigens are tested. Pos or neg, transfused or no, does not matter. I would think that the charge code would be the same regardless of what the antigen typing results would be. Scott

1. Febrile 1-2 C. 2. Measured from the baseline, which is just before the transfusion starts. 3. Cultures are done only when directed by a pathologist or other physician. 4. and 5. These are nursing calls.

We are a 220 bed trauma 2 hospital. We do not have the luxury of having a large number of specialists for each area. We have many generalists here, especially on evenings and nights. In general, we do a 4-5 week training period for the BB area, and try to make sure they are rotated through BB on a regular basis. First shift BBers are available at all times by phone. We ahve few problems. Scott

Thanks for the tip! We have not had any particular problems but we will refresh the balance card! Scott

You could call your local blood donation center and ask what they do with their extra plasma. Scott