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Posts posted by Dansket
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I'm finding it strange that they would even run the whole Resolve B panel when they suspected anti-D from screen/Resolve A, but that's me...
I agree with you. However, this scenario was intended as an example to pose the question, "Whenever you have a reason to run Resolve Panel B and the K+k- panel cell is agglutinated, can you exclude anti-K if there are one or more K+k+ cells that are not agglutinated?"
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We routinely test unwashed cord blood samples on ProVue without any problems.
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Is there consensus that anti-K cannot be excluded if a single K+k- panel cell is agglutinated regardless of the number of K+k+ panel cells that are unagglutinated?
Using ORTHO Resolve Panel A for a patient with weak anti-D (reacting 2+), anti-K is excluded on the basis of a single non-reactive K+k+ panel cell. If you add Resolve Panel B, anti-K is/is not excluded based on 1 panel cell that is D+, K+k- and 2 non-reactive panel cells that are D-, K+k+?
With these findings, would your current policy require transfusion with K-negative red blood cells?
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We started this practice when we went live with our new computer system but experienced a lot of resistance. Our pathologist would like a concensus of how many Transfusion Services actually requires a second ABO/Rh when NO previous historical blood type is available. YES or NO answer would suffice. Thanks
YES, we do
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Elin,
There was a white paper written by John Judd regarding a comparison of two cell screen and three cell screen using standard tube testing at the University of Michigan. Their conclusion was that differences were more attributable to variation in technique used by staff to resuspend red cell buttons. If you are using standard test tubes, you could make a case for using a 3Cell screen with a staff of generalists.
Dan
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I am being pressured to do emergency release units without a label. I have contacted CAP, and they said I need two identifiers. What policies are out there? Do any of you give O neg units without two patient identifiers?
Is your facility a trauma center? Was there a specific incident that triggered this request? How quickly can your staff issued uncrossmatched blood? Do you use a blood bank computer system? We will issue group ONEG rbcs from our Meditech system with only the patient name, usually John Doe using a customized NPR report. But we are not CAP accredited.
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We are looking into purchasing a new blood bank refrigerator. I am depating between a Helmer or a Revco (from Cardinal). We do have a Revco in our department currently, but I have never tried a Helmer. Just curious as to other people experiences.
I like the magnetic door seal on Helmer products. Alarm testing is easily done!
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Is it possible for a pregnant patient to type D negative (no weak D testing performed), then at delivery type as 2+. I recognize this is likely either a tech error or a phleb error, but I was wondering if anyone knew of this happening?
Thanks
Teresa
There could be several reasons, one is a large fetal-maternal hemorrhage. I suspect that since Weak D testing was not done and given a 2+ reaction with anti-D that patient is Weak D positive.
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I think it is optional if you put the calibrated thermometer in air or glycerol. If you do put it in glycerol, it should be a very small volume of 10% glycerol, e.g., less than 25 mL so that it will better reflect ambient air temperature. Our thermometer is in air.
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I am looking for documented support to stress the fact this needs to be done daily.
Any help would be greatly appreciated.
You might review Chapter 1 Quality Systems: Theory and Practice of the current edition of the AABB Technical Manual.
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http://www.statspin.com/products_us/Express3.php
See this site. There is a link to a study.
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A good project would be to challenge the long-standing practice of screening(ABO, Rh and DAT) for HDF/N on every newborn. Start from the endpoint, i.e., which newborns are identified for therapeutic intervention. Is therapy initiated based on the results of HDF/N screening tests. If not, why not. Are there infants treated for hyperbilirubinemia who are DAT negative and ABO compatible with mom? Does the DAT reliably predict which infants will require treatment? If not , then why do a DAT routinely on every newborn?. Just my rant....
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We do not perform computer crossmatch here and I am very interested about computer crossmatches. I've asked a friend of mine who is SBB, he said the way the guidance is written if clinically significant antibodies are not detected then you can rely on computer crossmatch but if there is ABO typing problem you can not. As for performing IS in addition to gel, he said blood bankers have different opinions but those who get inspected by AABB and FDA will definitely perform IS to be compliant.
Your SBB friend is correct. However, the FDA document referenced is for guidance, it is not regulatory.
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Does anyone require 2 blood types from different phlebotomies before issuing type specific plasma products?
This is the gold standard for correct classification of a patient ABO prior to blood transfusion. ABO typing of two independently collected blood samples will detect WBIT (Wrong Blood In Tube). Testing the same blood sample twice may detect testing/clerical errors but not blood sample collection errors. The reason we do this for plasma components is standardization of the process (establishing the patient ABO type) that minimizes the number of decisions to be made prior to issue of blood for transfusion. We follow the same process (specimen collection and pretransfusion testing) for Type and Screen or Type and Crossmatch. The decision to collect a second blood sample is made by the person doing pretransfusion testing, not the person doing specimen collection. Unsolicited blood samples are rejected and discarded.
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To properly comment, it would be useful to know if compatible crossmatches are demonstrated without prewarming to thoroughly characterize the patient's antibody reactivity.
Given a negative antibody screen and that the purpose of prewarming is to minimize false-positive agglutination, I don't see the point in prewarming crossmatches. The comment in the computer may have been appropriate at the time, but the transient nature of patient antibody requires that information be updated as situations change.
I would discard a specimen that had been incubated at 37C for over 6 hours. Our SOP requires that specimens be stored at 2C-8C when not being tested.
Based on your narrative, it seems that the processes in your laboratory foster problems rather than solve them, e.g., incubator not located in blood bank, no visual indicator posted in blood bank that a specimen is being prewarmed, computer comments out of date, prewarming an entire blood sample rather than an aliquot.
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Prior to transfusion of any blood component, we require ABO grouping on blood samples from two different venipunctures for all non-group O patients with no historical ABO on file.
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Dan, my current position is at a rural facility. Its not at all about getting type apecific because it is "better" but because of inventory. On a perfect day i have at most 8 units of O neg and a stat order from my supplier will take minimun an hour. I can give quite a few units in an hour even just to stabalize and ship the patient. If i can determine that my 23 yo female trauma is actually A pos and give type spwcific I have a lot more inventory to work with.
My situation is very similar, we are not a trauma center and 35 miles from the donor center (typically 1+ hours for a delivery). Our minimum inventory level for ONEG is also 8 units. If we exhausted the ONEG rbcs, I would switch to OPOS (minimum inventory level of 18 units) before I would issue uncrossmatched non-group O rbcs.
Who knows what Nursing will do, particuarly if there is more than one patient needing uncrossmatched blood at the same time?
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Malcolm,
There is an article titled "Debunking the 30-Minute Rule" in the May 2010 edition of AABB News published by the American Association of Blood Banks. The author states, "It is unacceptable to use the 30-minute rule as an absolute and universal rule. It is acceptable, however, to include a specific time frame for the reissue of blood products in a facilitiy's policies and procedures if the time frame has been validated in that facility".
Furthermore article states that it has not been acceptable to use any other metric but temperature since the AABB published specific requirements for the reissue of blood in the eighth edition of the AABB Standards in 1976.
From a regulatory standpoint (AABB standards in US), it is unacceptable to reissue whole blood or red blood cells that have been allowed to warm above 10C or cool below 1C.
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All,
With the sudden onset of apparent life-threatening hemorrhage, patient care systems are stressed to the limit and it becomes a potentially dangerous situation that can become a sentinel event. I really don't understand blood bankers who boast how rapidly they can produce an ABO typing on an individual so that they can issue "Type-Specific" uncrossmatched blood. You cannot harm a patient issuing group O Red Blood Cells, it is virtually impossible. You can harm a patient by issuing non-group O Red Blood Cells for a variety of reasons!
Why is it thought that a patient is better served by transfusion of "Type-Specific" Red Blood Cells as opposed to group O Red Blood Cells as a life-saving treatment?
I'm very interested in hearing the argument from those who practice issue of "Type-Specific" Red Blood Cells during resuscitation.
Thanks,
Dan
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I stopped using polyspecific antiglobulin antiserum and switched to monospecific Anti-IgG reagent in 1980. We also have been using solely EDTA blood samples with Gel technology for past 16 years. Current thinking is that red cell antibody only detectable by anti-complement-complement reaction in the test tube is probably very, very rare. Use of Gel technology also eliminates subjectivity and variation associated with manual tube testing that probably contributed more to failure to detect incompatibility than the use of EDTA blood samples or monospecific anti-IgG antiglobulin antiserum. Additionally, we use computer crossmatch, eliminating 98% of anti-IgG crossmatches.
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See this:
http://www.aabb.org/events/government/fdaliaison/bloodcomponents/Pages/flm041212.aspx
FDA Liaison Meeting – 4/12/12
Food and Drug Administration staff from the Center for Biologics Evaluation and Research (CBER) met with AABB's FDA Liaison Committee to discuss topics of mutual concern in the areas of donor and patient safety and product manufacturing. The committee includes liaisons from AABB, the Advanced Medical Technology Association (AdvaMed), America's Blood Centers (ABC), the American Red Cross, the Armed Services Blood Program, and the College of American Pathologists.
Effective date of new requirements vs. discontinuation of requirements no longer in effect
The final rule published January 2012, titled "Revisions to Labeling Requirements for Blood and Blood Components, Including Source Plasma" (effective date July 2, 2012) includes updates to several regulations that will eliminate the need to use variances related to ISBT labels and expiration time of thawed FFP. As with any rule or guidance document, new requirements or recommendations must be implemented by the effective date and may be implemented prior to that time.
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We are two hospitals with two blood banks and two different CAP numbers. Both hospitals are owned by same facility, and have the same computer system, same medical director and same supervisors. Can we transfer blood between the facilities without re-confirming unit blood type and/or unit antigen type if an antigen negative unit is at one blood bank and the other blood bank needs it?
Are your patients and donor units intermingled into the same database or separate databases for each facility? If unit of blood is physically delivered to facility A and logged into that computer system, does that unit also display as available in the computer inventory of facility B? Can facility A see the unit confirmation test results entered into the computer by facility B?
If your donor units are not in a database shared by both facilities, then I would re-confim the unit serologically. It may be simpler than making a bunch of computer transactions as a work-around.
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Dansket,
Not trying to play devils advocate; just curious how you would handle an extended down time? I too have generalists that are panicing as I am working to bring antibody ID in house for the first time in over 20 years. Are you willing to describe the process with the "commercially available computer program" (and perhaps share the name of the program) in some detail. This might be of interest for my situation. Thanks in advance.
Deny,
The process that I will describe is how I am implementing antibody identification in my current facility. We have been successfully participating in the CAP Proficiency Testing Survey JAT (includes antibody identification) for the past three years. We transfuse fewer than 1500 blood components annually. Prior to implementation, it was the policy to send all specimens with a positive antibody screen to a reference laboratory (90 miles distant). We do not stock reagent antisera (too expensive), rbc antigen typing of patients will continue to be done by the reference lab and donor units by the donor center (35 miles away). All testing is done on ProVue (2). The computerized antigen-ruleout program is AntigenPlus-ID version 7.4.5. We are using Meditech C/S version 5.64 with electronic crossmatch implemented.
We have two flow charts that I call Step One and Step Two. Staff are required to color-highlight the pathway they follow. Step One is used to determine if antibody identification is indicated. Step Two concludes after running Panel A only or after running Panel A and Panel B, that the reference lab is requested to do additional antibody identification or to do only rbc antigen typing on the patient.
We routinely do antibody identification on all antibody-screen-positive prentatal patients, all other patients with a positive antibody screen excepting patients with a history of clinically significant antibody when antigen-negative screen cells and antigen-negative donor rbcs are not agglutinated. These decisions are incorporated into the flow chart Step One.
Step Two flowchart is used only when antibody identification is indicated by Step One and guides the user in the decision to initially run Panel A only or to run both Panel A and Panel B simultaneously. Results of two-cell and three-cell screens and Panel A are entered into the antigen-ruleout program. Program indicates which antigen(s) cannot be excluded and the number of times a specific antigen was excluded. User is required to not only color-highlight pathway used but to also document the specificity of antigens that have only 1 or 2 rule-outs on the Step Two flowchart. User then totals the number of antigens excluded by the program plus the number of antigens with only 1-2 ruleouts. If the total is greater than one, then Panel B must run.
If after running a total of 16-27 cells, only one antigen cannot be excluded then user instructs the reference lab to type the patient for that antigen. While antigen typing is being done, user must color-highlight all the panel cells that are agglutinated and highlight all the panel cells that are positive for the single antigen. If there are no discrepancies and the reference lab reports that patient is antigen-negative then it is concluded the patient has the antibody. If there are discrepancies or the patient is antigen-positive, the reference lab is instructed to do full antibody identification according to their protocol.
This is a very conservative protocol (a baby step) that has reduced reference lab fees significantly and improved service to our patients. If patient has mulltiple antibodies or it is not a clear-cut single antibody or all the panel cells are agglutinated, we instruct the reference lab to do antibody identification.
As Blood Bank Supervisor, I am an active participant in this process being on-call 24/7/365. I tell my staff that everything they need to know to effectively process a patient with a positive antibody screen is on the flow charts and in our Meditech antibody identification results entry protocol.
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Anyone have any experience with Resolvigen?
72 or 48 hours
in Transfusion Services
Posted
That is correct, we have been doing this for years. It makes sense, otherwise, if you specify specimen outdate to the level of precision of hours, you have to monitor for expired specimens on an hourly basis. Typically (with exceptions), we release blood from crossmatch on the morning of the 3rd day after specimen collection.