Dansket

Goodchild listed the requirements for the "primary tag" that is attached to the blood container and what is used at the bedside check prior to transfusion. What you do (as well as what I do) is also attach a "secondary tag" to the blood container as a way of providing permanent identifcation of the unit to the patient. I don't believe any accrediting organization addresses our issue, UNLESS they state explicitly in their rules/regulations that the primary tag must remain attached to the blood container until infusion is completed!

I am intrigued by your idea. We also use a new TYPENEX band with each specimen collected. The TYPENEX code is printed on the form we attach to the blood container. We also print the Meditech specimen number on this form (for our internal use at the time of blood issue). The Meditech specimen collection labels we use are printed with a specimen bar code number (a six digit number) as well as a Meditech specimen number in the format 0821:BBnnnnnnn. We could print the 6 digit specimen bar code number in the same place as is currently occupied by the TYPENEX letter-number code. Nursing is required to match the TYPENEX code number printed on the form at the bedside with the TYPENEX code on the band on the patient, but they could just as easily match the Meditech 6 digit specimen barcode number on your "red band" with the same 6 digit number printed on the form attached to the blood container. So currently, our phlebotomists affix a bar coded specimen collection label to the TYPENEX band which for them is an identical process as that which Kathy is proposing. The TYPENEX band is constructed with a plastic overlay that waterproofs the Meditech label. How to do this with a generic "red band"?

What were the differences in reactivity comparing automated versus manual gel tests?

Adapting immune rosetting testing to gel methodology, particularly on ProVue.

Teresa, When you log units into your inventory, you are scanning the ABO/Rh barcode on the blood container label. This is stored in Meditech. For the unit to be updated to Available status after you enter your unit confirmation serological test results. those results must generate an interpretation that matches the ABO/Rh that you scanned from the blood component container label. As posted by whbb, a calculation must be devised to generate, e.g. OP without an anti-D result or ON with an anti-D result. This is possible

Our Meditech system is set up for electronic (computer crossmatch). Due to an oversight in Meditech's electronic crossmatch coding, it is not implemented for rbc units that have been issued using the Emergency Issue units routine. So, even though a patient meets all requirements for electronic crossmatch, the system does not recognize rbc units that were issued uncrossmatched as qualifiying for a computer crossmatch. We are forced to perform and enter serological crossmatch results. It is a computer flaw that I reported to Meditech! Some day they will correct it.

Gerald, How have you resolved this issue? Dan

Our Type and Screen test in configured in Meditech with an anti-A,B test in Line#1. If there is no blood type on file (our BBK specimen collection label is configured to print a historical blood type...we don't have to look it up in Meditech), we test the uncentrifuged blood sample with anti-A,B. That test result is entered in Meditech, saved and filed. If the anti-A,B test was agglutinated (a positive result), the test CONFIRM is reflexed on a new blood sample request (Using the LIS Enter/Edit Order Group Dictionary). As a result, specimen collection labels are automatically printed on the phlebotomy label printer. There is a separate blood type calculation (BTU) created for the test CONFIRM. Type and Screen uses (BT). If the anti-A,B test is not agglutinated, Meditech relexes the test CONFIRMO (BTO), that is added the same specimen and when filed with the Type and Screen test results generates the second ABO grouping blood type. A second venipuncture/separate specimen number is not required for our protocol. Whenever blood components are requested, Meditech is configured to automatically add a Type and Screen to that request (in the absence of a current Type and Screen) at our facility. This protocol is limited to Type and Screen only, we do not do this for prenatal ABO/Rh typing.

At our facility, 25% of patients for whom a Type and Screen is requested, have no historical blood type on file. As part of our protocol (because we use TYPENEX and the ID band CODE number is integrated into the computer result entry protocol), we don't use specimens from Heme/Chem. In a previous facility, I recall that about 16% of those patients had a hematology specimen that we could use in Blood Bank that had been collected by a different venipuncture.

Be aware that after rbc's are issued uncrossmatched, Meditech does not allow computer crossmatch of those unit(s) regardless of a negative antibody screen, no history of clinically significant antibody and two blood types done.

David, Whether it is set to Y or N, it has no effect on this issue. Dan

Are you planning to implement the electronic crossmatch?

Gerald, 1. Enter results for anti-A, anti-B, anti-D, Rh control, A1cells and Bcells for Group O Rh positive. 2. Observe the calculated ABO/Rh in the blood type field. 3. Move the cursor back up the screen to the line for anti-A 4. Change the anti-A result from 0 to 4+ 5. System should display warning "Invalid blood type calculation" 6. Click on "OK" 7. Press F12 to Save 8. Press spacebar 9. Press F12 to file 10. Re-enter specimen number 11. Observe that OPOS is displayed at the top of the screen, yet anti-A was resulted as 4+

Currently we are updating from Meditech C/S 5.64 to Meditech C/S 5.66. During a validation scenario, I discovered that it is possible for a user to enter and file serological test results that do not match the calculated blood type! I reported this to Meditech and they offered this solution (overnight Saturday-Sunday ). Background Whenever a Blood Type calculation is created in the BBK Calculation Dictionary, Meditech inserts generic code below into the Calculation Formula field: Existing code [bbk truth table]^X, IF{'X [bbk err msg]("Invalid blood type calculation.")}, X; Enhanced code [bbk truth table]^X, IF{'X [bbk err msg]("Invalid blood type calculation.")}, IF{'X [f bres delete]^X}, X; The introduction of the line IF{'X [f bres delete]^X}, tells the system when the answer is not equal to the calculation for X then delete the calculated result for the target test, BT. As a result, whenever an “Invalid blood type calculation” warning is displayed, system also erases the currently displayed blood type calculation, preventing a user from filing serological test results that do not match the calculated blood type. I strongly encourage Meditech users to take advantage of this enhanced code to prevent the potential for ABO incompatible blood transfusion.

There are two diluents, MTS Diluent 2 and MTS Diluent 2PLus that should not cause or prevent agglutination. If you are doing QC to determine that the diluents are inert in all situations, you would have prepare test cells suspended in each diluent. You would then have to test the cells in MTS Diluent 2Plus against each gel reagent (anti-A gel, anti-B gel, anti-D gel, Buffered Gel (immed-spin xmatch), Monoclonal Gel) and test cells in MTS Diluent 2 against anti-IgG gel (both DATand -IgG xmatch) using a test cell that gives a positve result and also a test cell that give a negative result.

I agree with David. Theoretically, testing one vial of each lot each day should be sufficient. However, it would not detect a vial from a non-QC'ed rack that had been mishandled or inadvertantly contaminated during usage.

Our requisition is the 'set of specimen collection labels' submitted with the blood sample container that is identified by a specimen collection label. So regardless of a truncated long patient name the 'requistion' does match identically to the label on the blood sample container..

1. Currently in a small facility with an average census of <50 patients. Active, ER, OB and Surgery. Average of 74 Type and Screens monthly. Transfuse 100-120 RBC monthly. 2. Our goal of 70 minutes is met 80-85% of the time. 3. Receipt to Verify. Samples are delivered directly to Blood Bank unspun. Centrifuge for 3 minutes with Statspin. 4. Two (2) ProVues, no manual testing (tube or gel) is done. 5. We are using Meditech 5.64 going to 5.66. Have a custom NPR report to download data and then sort in Excel. 6. We have similar situation as LCoronado as a barrier to reducing TAT

I QC a reagent Shipment/Lot on-receipt and then QC on Day of Use. I do not QC a vial retreived from storage (of a Shipment/Lot that had been QC'ed on-receipt) after Day of Use QC had been done. Day of Use QC and On-Receipt QC may be performed simultaneously. This protocol is based on the assumption that QC is performed/documented in a timely manner and reagents are stored properly. Is Pa referring to the State of Pennsylvania?

Who is your accrediting agency? Do you use a computerized laboratory information system? We don't require phlebotomist initials/signature on the blood sample container label because that information is captured in the LIS in the Collect/Receive blood sample routine after entry by the phlebotomist.

Our goal was issue 2 units of RBC in a cooler into the surgery dumbwaiter is less than 5 minutes using the electronic crossmatch. Over time all staff could do it in 3 minutes or less and some could do 1 unit a minute. Of course a cooler was not used for RBC issued into the pneumatic tube system... The timer started ticking upon receipt of a request to issue blood component printed on our blood bank printer. We scanned a barcode printed on that form into SoftBank, performed the electronic crossmatch, printed a crossmatch tag and then scanned the crossmatch tag and bag into the blood issue routine. RBC unit bagged in biohazard bag and put into pneumatic tube carrier. This process above did not require use of the patient blood sample. No serological testing was done for patients who qualify for the electronic crossmatch.

There is an article titled "Debunking the 30-Minute Rule" in the May 2010 edition of the AABB News. The 30-minute rule ignores the laws of thermodynamics and is unacceptable today. The temperature must be taken on all units returned unused to determine if the unit can be re-issued for transfusion. You didn't mention the pneumatic tube transit time. It is likely the reason why units are exceeding 10C as Deny Morlino mentioned.

If you implement semi-automated blood bank testing, you must also consider 'backup' when your semi-automated instrument is out of service.. I prefer gel because both manual and automated methods use the same reagents. If you use manual tube Plus a semi-automated instrument, you have to maintain two reagent inventories, and maintain staff competency with two methods. In a small facility, I prefer to minimize the 'overhead' associated with multiple testing methods.. Use manual gel to backup instrumented gel or better yet, have two automated instruments to backup each other!

Consider doing a survey in your facility of all newborns treated with phototherapy prior to discharge. Note the mothers and babys ABO/Rh, DAT results, and Bilirubin levels for each newborn. Look for associations between DAT results, how many newborns treated with phototherapy had a positive DAT, negative DAT? How many newborns were ABO incompatible with mom? How many were ABO compatible? How many infants had no ABO, Rh or DAT testing done but were treated for hyperbilirubinemia with phototherapy? I did this on 1350 newborns of whom 26 were treated with phototherapy. There was no correlation between ABO, Rh and DAT results. 13 newborns were treated who had a negative DAT. My conclusion was that routine ABO and DAT testing on all newborns had no predictive value identifying infants who would ultimately require phototherapy to treat hyperbilirubinemia. Bilirubin levels do!

There is a Centralized Transfusion Service in Pittsburg, PA. Also Puget Sound Donor Center in Washingon state did operate a centralized transfusion service.