SMILLER

In general, here the anesthesiologist is responsible for transfusions during major surgeries.  A tech or nurse would do the documentation in OR.
When all areas used transfusion forms that were attached to the units, regardless of where they were transfused, copies of those tags were sent back to the BB.  We reviewed them for completeness and anythin g else that may have been missed, such as a raise in temp, and then sent the reports back to the managers in charge of those associates for comments and corrections.  I believe the deficiency statistics were reported to the transfusion committee.
Now the transfusion vitals, etc. are put right on the electronic chart.  Deficiencies are almost non-existent as the system alerts the person entering data when something is amiss.
Scott
 

For the simular case we had, all we did extra was a 30 min, 37 C settle test (unspun) to resolve the positive reverse A cells (A patient).  We did not see a point in doing anything else--the gel screen was negative.
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

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

We have had some colds, non-reactive in solid phase but reactive in tube. In above case, I would approach it by performing antibody identification by tube method. (since I am conservative) 

Remind me not to travel to Brazil if I ever require a transfusion!  

One reference I read puts the prevalence of EDTA-clump-able platelets at less than 0.2% in hospitalized patients and only 0.1% in the general population.  It's a purely in vitro phenomenon so I would guess that donation processing does not include screening for it, as it would have no in vivo significance.  Interesting question though.
Scott
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538042/

Yikes!  I would hope that your facility's patient and specimen ID policies have improved since those days!
Scott

That was my point.  Yes, if the sample is the same type as the patient in the bed but wrong patient's sample, it won't catch WBIT.  However, it has saved us several ABO HTR's in my career (30+ years).  I call that a good catch! 

I am not sure that there is a fool-proof way to detect WBIT, but checking the ABO at the bedside will, at the least, help avoid death by ABO incompatibility, even if the T&S testing was done on a different patient.
Scott

No, I knew what I meant.

Agree with those who say that as long as it cannot be ruled as an artifact at some point, one must do a AHG crossmatch for the life of the patient.
Scott

That may be because she missed the 4th year of college where she has to start thinking about what to do after she finish school and real life situations. 

A very bad option.  Look at it this way.  You probably could not do their job.  They cannot do ours - and ABO matching is THE single most important in transfusion.  Most ABO types are, I agree, pretty easy, but some are most definitely not.  For example, could a nurse tell the difference between a group O and an Oh?  I have huge doubts.

If by "odd antigen" you mean a low incidence/frequency antigen on that specific A1 cell/donor, it should be easy to resolve using another A1 cell (or set of Reverse Cells) - the forward and reverse would compliment each other. However, if everyone is having problems with this patient, it's unlikely to be the reverse cell(s).
Is the GI bleed due to ulcers ? H. pylori, perhaps. I think I read that some folks with H. pylori make cold autoantibodies.

I suggest you contact other facilities in your area and see what they have been doing.  You will want to know how they are satisfying any regulatory requirements with whatever method they use.
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

I suggest you contact other facilities in your area and see what they have been doing.  You will want to know how they are satisfying any regulatory requirements with whatever method they use.
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

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

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

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

However, none of those agencies state that the facility must follow AABB Standards nor do they mention them during an inspection.  Only AABB inspectors can cite for non-compliance with an AABB standard.