Dansket

The acceptable operating environment temperature range for ProVue is 18C-28C. For gel card storage it is 2C-25C.

I would be surprised if this guru is currently responsible for the activities of an active transfusion service. It is easy to state, "Get it right the first time". I think the guru's logic is flawed in that it compares apples to oranges! A lab test result can vary from minute to minute, ABO blood types do not. Physicians can challenge a lab test result if it doesn't fit with their clinical assessment and request repeat testing or repeat specimen collection. Not so with a ABO blood type. How does this work when patients share identities and insurance cards? I would also challenge the guru's logic regarding the inability of donor centers in the United States to guarantee that the blood container ABO/Rh label is correct.. Why can't they "get it right the first time"? Transfusion Services are required to confirm the correctness of the ABO container label, because the donor center cannot guarantee it is correct. The electronic crossmatch is based on the logic, Determine the ABO/Rh (donor center) and then verify it (transfusion service). This logic works for both donor units and for patients, "Trust but verify".

Don't understand how Check cell reactions can be graded as 1+, 2+, 3+ or 4+? Technically all Check cell reactions are "mixed-field". In an negative antibody screen tube (with reactive anti-antiglobulin reagent), there is one drop of unagglutinated antibody screen cells and one drop of agglutinated Check cells. Back in the old days using paper worksheets, we used a check mark to indicate "macroscopic agglutination" observed after addition of check cells to a negative antiglobulin test.

Between Donna and David, would you tell us out of the last 100 workups you did, under what circumstances did a finding of hemoglobinuria ( in the absence of no other finding) lead to the discovery of an incompatible blood transfusion due to an previously undetected red cell antibody? In other words, what am I missing by not doing what you do?

  No, we follow AABB Standard 5.13.3.2 "...a sample shall be obtained from the patient within 3 days of the scheduled transfusion. Day 0 is the day of draw." Day zero=calendar day 1, Day one=calendar day 2, Day two=calendar day 3 and Day three=calendar day 4. Day four would be calendar day 5. Blood is good for 4 calendar days, not 5.Stated another way, The blood sample is not one day old on the day of draw. It does not become one day old until the second calendar day of its existence. Blood may be transfused on calendar day 1,2,3 and up to midnight of calendar day 4.

Meditech is the most effective tool that I have to manage a group of Generalists. Every process is done in Meditech, I do not have any log books of any kind. Do you have control of the BBK module or does IT control it? Have you implemented the computer crossmatch? Doing so has a huge impact on eliminating low-value processes and stream-lining your operation. PM me if you want to know more.

Retesting the same specimen by the same tech may detect testing errors but it will not detect specimen collection errors. It you want to detect WBIT, collecting a second blood sample would be more effective.

It is the responsibility of the laboratory phlebotomy staff to monitor and remove outdated blood bands. I ask them to check every patient they draw each day for a blood band. If present, then check the specimen collection date on the blood band. Count 4 days (specimen collection date as day zero). If day 4 is today or in the past, band is outdate and must be removed.

Malcolm, If I'm incubating patient serum/plasma with test cells at 4C, I would also include an O cord cell (we have these in a hospital setting) as well as an auto-control. Dan

I would term this "institutional inertia". Is this practice documented in a procedure manual? If so, what was the date of implementation? Are you in a position to compile some data comparing immediate-spin tube test results with un-centrifuged tube test results?

Our pathologists do not make comments in the computer system regarding antibody identification. Within Meditech, there is a antibody database and a field which defines antibody as clinically significant or not.

John...I hate tube testing. Have not done tube testing since the last century and could never go back!!

David is correct when the system depends on humans to detect discrepancies. The following is how I use the computer system to issue blood: 1. Patient case number (encounter, financial) barcoded label is scanned (barcode label is affixed to Request to Release Blood Component form presented by Nursing) 2. Scan bar coded (ISBT-128) Donor Identification number on label of blood container selected for issue. System will not allow scanned entry of Code 39 bar code. 3. Scan bar coded (code 39)Donor Identification number printed on crossmatch tag that is attached to the blood container. System will not allow scanned entry of an ISBT-128 bar code. Step one establishes to whom blood will be released in the computer system. Step two identifies the selected blood container to the computer which instantly determines if blood container is crossmatched/assigned to the patient. Step three verifies that the donor identification number on crossmatch tag matches the donor identification number on the blood container label.

Megan, We also use Meditech C/S Ver 5.66 that is validated for electronic crossmatch. If a patient does not qualify for the electronic crossmatch, we do a both buffered gel crossmatch and an IgG gel crossmatch. This is our understanding of current FDA requirements.

Did your facility actually experience "grotty reactions" after extending the interval of the drain/refill cycle?

ProVue User's Guide recommends that the Wash Solution bottles be drained/refilled weekly. Does anyone extend the time interval to "every two weeks" or "monthly"?

Our STAT investigation for any reported Adverse Reaction to Blood Transfusion includes pre/post DAT, pre/post ABO/Rh, Clerical Check and Visual Inspection for hemolysis. No further testing is done if all findings are 'negative'. Post-reaction urine is collected but no testing done unless there is a positive finding in the STAT investigation.

No, we do not follow such a policy (it may be unique to your facility!). To address this issue operationally, I use the AntigenPlus program. http://www.antigenplus.com/ This program standardizes the rule-out process (excluding antigens to which the patient may have antibody). This is only the first of the many steps required for antibody identification. Everyone in my staff of generalists is required to use the program.

Any more detail that you can provide on the "weakly reacting with anti-A". Was it a microscopic reading? Was it mixed-field agglutination? Were the original results confirmed by a reference laboratory? Assuming these results are from standard tube tests with polyclonal anti-A and anti-B? I would test with monoclonal anti-A,B. I would incubate the reverse grouping test for 5-15 minutes at room temperature, centrifuge and read.

This lab director has not worked the bench in blood bank in over 30 years. We use gel exclusively. She does not think she needs to go through the usual 3 week training program. She has not been trained to read gel cards, but has read the MTS Gel Card Interpretation Guide. How would your facility react to this situation?

Does the Lab Director have to be formally trained (in the same manner as any CLS that is new to your facility)in Blood Bank?

The time it takes to feel comfortable... I think it is based on two issues, 1)how disciplined (consistent) you are and 2)the scope of your aggregate experience. It has been said, that an individual may have 5 years of experience of knowledge building or 1 year of experience multiplied 5 times which is, in essence, only 1 year. I agree with Malcolm, 12-18 months.

I have always trained my staff with these words, "Record what you see, not what you think it should be." In other words, proceed based on observations, not expectations.

wagnmell, I looked at what we're doing and have the same problem. I'm investigating now. Dan

What is an FMST?