jerriemc

Thanks for your replies. We have had several instances this week where the physician has written an order to do the type and screen day of surgery. This just seems like we are asking for a disaster, but the OR director thinks lab is over reacting so I wanted to give her some data on the importance of having the type and screen done before the patient goes to surgery.

Does anyone know where I can find some data about fatalities resulting from patient's not having blood bank testing done prior to surgery? Example patient doesn't have type and screen ordered until day of surgery and the patient has an antibody and the blood bank cannot find compatible blood? Thanks for your help

We retype the units and perform the cross match. Our reference lab does not perform cross matches they just screen units for the antigen. We had a real problem with this once. They sent us units on a patient negative for the antigens they had found antibodies too. All 4 units were strongly incompatible. I called them and they sent 2 more units that were also incompatible. I finally spoke with the reference lab supervisor and she agreed to cross match units before sending them. About an hour later she called me back asking for more specimen on the patient they were going to have to send her off to another reference lab.

Be careful with this practice. We used to do this but discontinued it when a blood bank armband was found on the chart of a patient who was Jehevoh's witness. The nurse looked closer and discovered it was for another patient. After that we started making the outpatients wear their armbands home. We try to stress to them that is for their own safety. We also let them see the actual armband numbers on their blood specimens. Most of them appreciate the safety measures once they are explained to them

Does anybody extend the time limit for type and screens on patients having outpatient surgery? We have some new surgeons that want their patients to come in 1-2 weeks prior to surgery for their pre op lab work. Because of the time sensitivity of Type and Screens, they have started waiting until the actual day of surgery to order the type and screen. This just seems like a disaster waiting to happen. This morning our phlebotomist was drawing a patient's blood while the transporter was waiting to take them down to surgery. I was wondering how other hospitals had dealt with this same problem? Thanks for your input.

I don't remember where I got this information, but one reason that we do not use only male plasma is that more women donate than men. The concern is that this would greatly decrease the amount of plasma available.

Thanks to everyone for your replies. I must say we are very fortunate that our reference lab does not talk down to us or make us feel inferior, they try their very best to help us and even send reference materials. I ( and all my patients) are also very fortunate in that all my blood bank techs are very conscientous and worry about patient welfare. We all have a hard time issuing blood to patients when we have seen strong reactions in gel with our own eyes. Another reason we get so concerned may be that we are a relatively small hospital(100 bed) and we do alot of our phlebotomy and we get to know our patients well.

How many of you currently perform auto controls on all patients? We currently do and are looking at eliminating them on patients with negative antibody screens. Just curious what everyone else is doing? Thanks in advance for you input.

My favorites are the hospital employees that are really big in our Relay for Life which raises money for Cancer research. They constantly ask the lab to buy things from them for the cause but then will not donate blood. Don't they realize how many units of blood are given to oncology patients.

We are currently using the gel method, but we have had several occasions where we have gotten reactions on our screening cells and panels that we cannot definitively id the antibody. We send the specimen to ARC ref lab and they get all negative using the tube method. I understand that the gel picks up alot of nonclinically significant reactions. The problem is the pathologists and most techs do not feel comfortable giving blood to a patient that we get such strong gel reactions on and then ARC tells us everything is negative. On occasions such as this I am often asked by techs why doesn't ARC ref lab use the gel system? Thanks to everyone for their input.

This is a question I have asked several Ortho gel reps/trainers etc and they never can answer. If gel is so superior to the tube method why doesn't the Red Cross reference lab use the gel system?

Back in the stone age of manual requests. I got a request for a CBC on a patient in AM and also got a request for a platelet count in AM on the same patient. After I hand carried the results to the ICU(like I said this was in the stone age) I got a call from the patient's nurse " I got my CBC on bed 6 but I did not get my platelet count how much longer will it be?"

Dr. Hannon thanks for the reply. One of our othro surgeons is having a hard time with the Rehab hospital. If a patient is anemic they either won't accept them or they accept them and then send them to the hospital the next day for a transfusion. He hates for the patients to be put thru the ordeal of getting put in an ambulance, brought to the hospital, given a transfusion and then put back in an ambulance to go back to the rehab hospital. I am going to forward these studies to him, maybe he can convince the Rehab hospital to lower their standards.

One problem we have had with trying to reduce ortho patient blood transfusions is new guidelines for sending patients to rehab facilities. Often our patients were anemic pre surgery and did not lose much blood during surgery. They are tolerating the anemia and the orthopedic surgeon does not want to transfusion, but the Rehab facility will not accept them with a lower than normal H and H and the patients need rehab, so they end up getting transfused.

My concern is isn't there a potential to introduce bacteria into the bag of platelets when you get an aliquot for testing?