[Exclusion of anti-E in the presence of anti-c]

All,

 

What do you report on a CAP survey, when anti-c is identified in a sample that you can't rule-in or rule-out anti-E?

[Exclusion of anti-E in the presence of anti-c]

From: Guidelines for Antibody Identifcation, American Association of Blood Banks, 2010. Additional Guidance and Testing, page 21

 

"2. Exclusion of anti-E and anti-C may be completely eliminated for patient with anti-c and anti-e, respectively, because of the paucity of c-E+ and e-C+ donor units. Policies do differ in this regard.

 

    a. In addition to selecting donor units lacking the antigen(s) corresponding to the known antibody(ies), select donor units lacking the antigen(s) for which antibody exclusion has not been performed.  For example, select c-E- units with anti-c and C-e- units with anti-e, even though c-E+ or C+e- red cells were not tested and the presence or absence of anti-E or anti-C, respectively, is unknown.

 

    b.  Select donor units lacking the antigen(s) corresonding to the known antibody(ies).  When transfusion is requested, an antiglobulin crossmatch of the appropriate antigen-negative donor cells will be required (ie, c- or e- units would be crossmatched).  If the patient also had anti-E or anti-C, not excluded by antibody identification testing, antigen-positive donor unit would be incompatible."

 

 

Which policy do you follow, A or B?  ( assume,  that in either case, antiglobulin crossmatch is done.)

 

Thanks,

 

Dan

 

 

[Do you have a weak D policy when tested on the Provue?]

Do you have data to share on the incidence of ProVue 1-2+, while test tube (D and Weak D) is negative?

[Do you have a weak D policy when tested on the Provue?]

We don't do Weak D testing on adults, only newborns.  Doing Weak D testing on specimens yielding 1-2+ on ProVue routinely produces the same strength of reactivity in the Weak D test as in the Immed-spin D test, i.e., 1-2+. We do Weak D testing on Provue using ORTHO BioClone Anti-D.  We interpret these test results (1-2+) as Rh Positive.  We don't do any D/Weak D testing in tube.

[Meditech Emergency Issue & Electronic Crossmatches]

Bankergirl,

 

    Meditech does not evaluate (during BBK Enter/Edit Results entry) emergency issued units for electronic crossmatch. Meditech expects user to enter serological test results for immed-spin and anti-IgG.  Meditech sees NP as a negative result (no different than no agglutination)  so that is why your BBK Calculation interprets your NP entries as "Compatilble? Y".

 

By configuring the BBK Calcuation to not ignore NP, it interprets the crossmatch as "Compatible? N".  User has to override this and that override is captured in the override warning report that I review daily. 

[Meditech Emergency Issue & Electronic Crossmatches]

Thanks, Dansket, I tried this out yesterday, my interpretation was actually compatible, and it worked like a charm.

Meditech has a DTS in developement, will advise whever it is installed on my system.

[Meditech Emergency Issue & Electronic Crossmatches]

BankerGirl,

 

I purposely configured the crossmatch BBK Calculation to report "Compatible? N" so I would have an audit trail if someone tried to bypass the system and to simulate an electronic crossmatch on a patient who does not qualify.

 

Dan

[Meditech Emergency Issue & Electronic Crossmatches]

Essentially, our work-around is to manually enter NP as the test result for both T-type tests.  Based on our BBK Calculation for the crossmatch, manual entry of NP will generate an interpretation of "Compatible ? N". 

 

User then changes the N to Y and is prompted by Meditech that interpretation does not match calculated result.  In our system, user can override this warning. 

[Meditech Emergency Issue & Electronic Crossmatches]

We are using Meditech C/S 5.66 and the electronic crossmatch.  We don't have the issue you're describing.

 

We have a single X-type Crossmatch test that has two T-type component tests: Immediate-spin and Anti-IgG XM.

 

The X-type test is entered in the Product dictionary on page 4 as an Associated Patient Test. for all red blood cells components.

 

So, whever red blood cells are ordered in Meditech, the X-type test is automatically added to the order or the RBC order count is incremented if it is an add-on to an existing order.

 

If a patient qualifies for electronic crossmatch, Meditech automatically enters a default result of NP for both Immediate-spin and the Anti-IgG T-type tests.  These results are interpreted as compatible according to our entry in the BBK Calculation dictionary.

 

When uncrossmatched blood has been issued (using the Emergency Release routine) and the patient has been subsequently found to qualify for the electronic crossmatch, Meditech does not enter default results of NP.  This has been reported to Meditech and they have acknowledged that this is a 'bug".   We developed a computer 'workaround' to avoid doing serologic crossmatches and entering serologic test results.

[Checking work in a paperless environment]

Gel cards are labeled with barcoded specimen label. Gel card results are keyed directly into the computer.   A single  individual is wholly responsible for results entry.

[Checksum digit at end of DIN]

Check the ISBT 128 website.  http://www.iccbba.org/    Review the definition of the DIN format.

 

The double zero is separated from the DIN by a space and printed in a vertical format. It is there for proper barcode scanning and not intended to be a part of the eye-readable DIN.

 

Do all your DINs have a double zero?  If you were to make them part of the DIN,. then all your donor unit numbers would end in 00!  This would visually reduce readability and decrease the uniqueness of each DIN.

 

I think your CLIA inspector was way off the mark on this non-issue.

[HEMOLYSIS AND AUTOCONTROLS]

^{We test in gel on ProVue and all specimens are collected in EDTA.  Antibody Screen, Major Crossmatch and Antibody Panels are tested with Anti-IgG Gel cards.  So we are not concerned with detecting antigen-antibody reactions that cause in-vitro hemolysis or rejecting hemolyzed specimens.}

[Complement Control]

The Anti-C3d reagent I am using states to interpret the immediate spin reaction before you incubate? It is Monospecific for Anti-C3d, complement the majority of times needs to be incubated to be detected. I am trying to find out an explaination why perform the IS?

Does the direction insert require two centrifugations of the test, immediately and after incubation even if the immediate-spin test is positive?

[ARRA and Meaningful Use]

Currently, we use a paper form (stocked in each Nursing station) that is completed by RN/MD and physically delivered to Blood Bank to obtain release of uncrossmatched blood.  It is very fast and is not dependent on patient being admitted to HIS, specifically ER patients.

 

Does your facility/IT department require that an order for Uncrossmatched Blood must be placed in HIS, i.e., to be consistent with some requirement that all orders must be electronically generated?

 

Would anyone construe this requiremen to mean that a paper form may not be used to order uncrossmatched blood?

 

Has anyone been told by their IT department, that the order for Uncrossmatched Blood must be placed in the HIS before blood can be released for transfusion?

[Confirming order before issue]

_{If an RN submits a properly completed Request for Blood Component form in person to Blood Bank and that blood component is available for issue, we release it after completing a computer transaction and retain the form.  What other steps does your facility require for confirmation?}

[Laser Paper for Transfusion Record]

We transfuse up to 150 units per month.  RN's are required to fax a copy of the Report of Blood Transfusion form back to Blood Bank (we have a dedicated fax machine). Medical Records routinely scans Report of Blood Transfusion forms into EMER.  I can also print a copy from the EMR.

[Bleach in the Blood Bank]

_{What is in your scut buckets, Test Tubes, Segments, Decanted saline from manual tube washing?  Are these buckets on the countertop or undercounter?}

[Use of K-Centra in massive transfusion initiation]

From what I read, this drug is for warfarin-reversal.  Are you thinking about off-label use?

[Donor retypes]

Does anyone's blood center or blood supplier perform donor retypes (from an integrally attached segment) for you?

 

It is on my wish list!  I suggested this to our local community blood bank, but no response as yet.

[Do you want your specimens to outdate at 2359?]

Dr. Pepper,

 

Per Meditech, Every time you pull an expired specimen into any routine, including the BBK Issue Units Routine, you will get a message that says:
 
"Warning: Specimen was collected ** hours ago and expired @@ hours ago."
 
The user will be asked to select whether or not he or she would like to Stop, Continue, or Edit.  So you can bypass it, but anytime that a user does it will show up in the BBK Override Warning Report.

 

Dan

 

[Do you want your specimens to outdate at 2359?]

I have autorelease XM hours set to 72 and autorelease time at 2359. The time seems to override the 72 hours and extend past it. This has worked fine for us for 4 or 5 years. Am I missing something?

 

Maybe. 

 

What is your entry for Specimen Expiry Hours in the  BBK Custom Defined Parameters?  For example, if your default entry is 72 hours, and a specimen was collected at 1200. Then Meditiech will expire that specimen at noon on day 3.  However, your crossmatches don't expire until 2359 on day 3. 

 

So, there is crossmatched blood in your refrigerator for 12 hours after the blood sample has expired.  This is my understanding.

 

Does Meditech display any warning when you issue blood using an expired blood sample?

[Do you want your specimens to outdate at 2359?]

Meditech users:

 

We have just installed a custom (not a rule but custom hard code) in C/S version 5.66 that causes all specimens to expire at 2359 regardless of the time of specimen collection.  It will not be generally available as a DTS.

 

If you want this feature, you will have to press Meditech for it.

[A Laboratory Director's Question?]

This was one of many multiple choice questions on an Antibody Identification competency assessment quiz.  A new CLS in training who answered the question incorrectly complained to the Laboratory Director. She wondered if it was a trick question.  When pressed by the director, the CLS could not offer any explanation as to why he thought his choice (#1) was the correct answer.

 

The correct answer is #2, other choices were "Leave it for the day shift" and "None of the above".

[A Laboratory Director's Question?]

I have a question for you. What is your lab director's blood bank back ground? I had a lab director once and his only qualifications for the job was a BS in business (long story). He would ask these kinds of questions. 

He is a CLS

[Duplicate samples in Blood Transfusion]

Was this an unsolicited blood sample or was it requested in the HIS/LIS?  If it is a computer request, I would cancel it in the computer or request nursing to cancel it in the HIS. If there is no compelling reason to store it (if I did store it, I would document it in the LIS), I would discard it  into biohazard trash.