SMILLER

And Happy Boxing Day!
Scott

My inclination is that since this is not in the package insert, this is violating the package insert and shouldn't be done prior to use for in date antisera.
 
I think you are right with that.  Is this written up in your procedures as well?  I would make a few changes.  Lab practices that are done "just because" should be looked at very closely!
 
Scott

I don't think that is correct about dumbing down to manufacturer's recommendations.  I believe the regs read that at a minimum, manufacturer's requirements for things like QC be followed.  CLIA/JCAHO/CAP regulations are often much more strict than what a particular manufacturer may suggest for their product. 
If you choose to not run a pos and neg control, you better have a better reason than, "the manufacturer said it was OK."
Scott

LOL!  We would send it to our reference lab!  We have other things to do here...
Scott

LOL!  We would send it to our reference lab!  We have other things to do here...
Scott

On p. 563 of AABB Tech Manual 18th edition, it only mentions that titer methods other than "saline AHG 60 minute incubation" in tube may result in higher titers and "should be validated with clinical findings" (see Malcolm's post, above).  So it does not seem to say one cannot use gel or other methods, just that you need to document validation.
I have always been a bit uncomfortable with identifying an antibody with gel (for a prenatal), then doing the titers in tube.  But then again, I guess it is the comparison of the series of tube titers that they are looking at.
Scott

"Do you want it to be faster and more hands-off or more exact?"  They really said that?  Yikes!
Scott

"Do you want it to be faster and more hands-off or more exact?"  They really said that?  Yikes!
Scott

On p. 563 of AABB Tech Manual 18th edition, it only mentions that titer methods other than "saline AHG 60 minute incubation" in tube may result in higher titers and "should be validated with clinical findings" (see Malcolm's post, above).  So it does not seem to say one cannot use gel or other methods, just that you need to document validation.
I have always been a bit uncomfortable with identifying an antibody with gel (for a prenatal), then doing the titers in tube.  But then again, I guess it is the comparison of the series of tube titers that they are looking at.
Scott

LOL! I knew someone would mention that Malcolm!
Here we only would use a scope to differentiate rouleaux from a "true" weak reaction when getting very weak macroscopic reverse typings or on an IS crossmatch. I am not sure why anyone would think to use it for a DAT or IAT.
Scott

If the DAT is negative, I would think that a post screen would be unecessary, as there was no transfusion reaction to begin with, hence nothing to stimulate any particular antibody.  (Theoretically I suppose, any transfusion may result in an "increase in titer", but no one does a screen after every uneventful transfusion.)
 
Scott

Whether you call yourselves Lean (or Six Sigma or some other facetious productivity name) or not, the reality for many labs these days is that generalists are more and more necessary to keep things going in light of personnel shortages,
We are a 250 bed level 2 trauma hospital, with a fair amount of Lab work on the type of patient population we see, including BB.  The only real "dedicated"  techs we have are in Micro (and of course, Histology). About a quarter of the techs on first shift are generalists that can work on a regular basis in BB (in addition to the main Lab area).  On second and third shift, virtually all of the techs work BB in addition to the main lab area.
Whether one has BB with all dedicated staff or no, the key is to have adequate training and competency, along with extensive references, including having good P&Ps available.  This is true for all areas of the Lab (and in health care in general!).  It requires a sharp and dedicated management model and staff.
Scott
 

We've been converting FFP to TP directly for some time now.  All of our thawed units start with a 5-day outdate.
 
Scott

We've been converting FFP to TP directly for some time now.  All of our thawed units start with a 5-day outdate.
 
Scott

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

From the My Two Cents Dept...
I would just point out that it is important that people doing testing understand what and why they are doing what they are doing.  I guess this goes without saying.  I am not a fan of throwing computer AI at problems when staff have trouble understanding what it is they are doing.  I get it that with staff shortages and what not, that generalists have a lot of hats to wear, but a computer algorithm should never be a substitute for appropriate education and regular, effective performance evaluation.
Scott

From the My Two Cents Dept...
I would just point out that it is important that people doing testing understand what and why they are doing what they are doing.  I guess this goes without saying.  I am not a fan of throwing computer AI at problems when staff have trouble understanding what it is they are doing.  I get it that with staff shortages and what not, that generalists have a lot of hats to wear, but a computer algorithm should never be a substitute for appropriate education and regular, effective performance evaluation.
Scott

Just to add a bit to what David has already explained.  I tend to think of dosage as relating to the amount of antigens present on the RBCs that you are using to ID the patient's antibody, and if the reagent RBC has lots of antigens of the type in question, then the reaction will be stronger.  This is really important for a patient whose antibodies are just developing--you want to use a reagent RBC with the strongest expression possible, and these are the homozygous cells.
For example, at our hospital, we use the 3 by 3 method for antibody ID (for each type of significant antibody, if the antibody is present, we want to rule in with 3 positive RBCs, and to rule out all the other antibodies, we want to have 3 negative reactions for those.)  So for antigens that "show dosage", we want at least one of those three rule out RBCs to be homozygous.
Scott

From the My Two Cents Dept...
I would just point out that it is important that people doing testing understand what and why they are doing what they are doing.  I guess this goes without saying.  I am not a fan of throwing computer AI at problems when staff have trouble understanding what it is they are doing.  I get it that with staff shortages and what not, that generalists have a lot of hats to wear, but a computer algorithm should never be a substitute for appropriate education and regular, effective performance evaluation.
Scott

From the My Two Cents Dept...
I would just point out that it is important that people doing testing understand what and why they are doing what they are doing.  I guess this goes without saying.  I am not a fan of throwing computer AI at problems when staff have trouble understanding what it is they are doing.  I get it that with staff shortages and what not, that generalists have a lot of hats to wear, but a computer algorithm should never be a substitute for appropriate education and regular, effective performance evaluation.
Scott

For platelets you can cut the dose in half with no worsening of clinical outcomes. Randomized trial in NEJM called the PLADO (platelet dose) study some years ago (Sherrill Slichter was the senior author).  Most platelets do little or no good, so this is actually a good idea for patients and helps with inventory in times of shortage.  Try to give ABO identical as the increment is higher, the duration of increment is longer and the patients bleed less.

More likely the slips must be hung onto at least until after your blood provider gets their payment.  If there is any dispute over what you are charged and/or paying for, then you have their packing slip to refer to as a sort of "receipt".  Doesn't seem like you would need to hang onto them forever.  May be a billing department requirement.
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

My experience is that interference from rouleaux and cold autoantibodies in Gel is not unusual but this may depend on your patient population. 
As rouleaux is not an antibody an AHG crossmatch is not required. If you IS crossmatch you must (in my opinion) saline replace so you show any agglutination is interference and can therefore enter a negative/compatible/non-reactive result into your LISS, probably with a comment.

With attention to blood utilization, the overall red blood cell usage has gone down.  Consequently blood suppliers have had to pair down the number of overall units they collect in order to avoid out dating products.  Since we are drawing a population, the proportion of desired units in that population (All Rh negs and all group Os) has not changed, but the absolute number of the desired we can acquire units has dropped.  Transfusion practices are still demanding nearly the same number of desired units as before blood utilization practices were implemented.  About half of the Rh neg units distributed go to a non-Rh negative recipient, often because hospitals do not want to "waste" them.  Perhaps if before making that decision to transfuse the blood bank contacted the blood center and asked if there was an immediate need to transfuse an Rh negative unit to an Rh negative recipient, we could better utilize the resources we have.
Also I believe the merging of blood centers has contributed to the problem.  Where the community blood center was usually able to manage the blood needs of the local hospitals, many are selling blood by contract to facilities miles away.  This has decreased the amount of ad hoc blood available for export.
The "low-titer group O" craze is also taking a toll because of the demand for repeat donors to fulfill the need to have Whole blood units with a 21-35 day out date, available for emergencies.
Most blood centers are trying to recruit blood donors by blood group now in order to avoid out-dating Apos and Bpos units. This means that Rh negative and group O donors are approached to give 2-3 times more often than donors of other blood groups.  The desired donors are complaining that they are being approached to give red blood cells too frequently and are starting to ignore our requests.
All of these issues (and perhaps others) are contributing to the nation wide blood shortage of the most desired units. Importing products is also difficult. If they are available at all, did you know that in order to import four group O negative units a blood center might have to also purchase 50- 100 group A Pos units?
Platelet utilization seems to be increasing.  Where do platelet donors come from? Usually whole blood donors. Sometimes the blood center needs to decide whether to take a group O product or obtain a platelet product based on the needs of the day. 
Thank you to those who are excellent stewards of the products you receive!  Blood centers are not shorting you because they are incompetent.  Frequently it is extremely difficult to obtain the most desired products any where at any price.  You can help your blood center serve you by being honest with your inventory.