Dansket

Also, if you are handwriting the expiration date and time, you might consider converting directly from frozen FFP to Thawed Plasma.  You will confuse the nurses greatly if you change the expiration date twice, with the last one being LATER than the previous one.  Experience speaking here.  It also save you from having to process the unit twice.

I would discard the entire inventory. Then I would wonder if there was an alarm activation. If not, why not? If alarm was activated, was action taken or was it ignored? Do you have a backup freezer?

AABB 5.11.2.1: "The completed label shall be affixed to the tube before the person who drew the sample leaves the side of the patient."
 
CAP TRM.40230: "All blood samples for compatibility testing are labeled at the time of specimen collection in the presence of the patient with..."
 
And as Malcolm says, even if it weren't against the standards, it's a very bad idea. So you need to:
 
1. Have your phlebotomy procedure state the above (nursing, lab, docs, phleb team, whoever draws specimens).
2. Have your blood bank P&P say you won't accept specs that aren't labeled as above (like the bags).
3. Why not put it into your hospital's transfusion policies as well, approved by the medical staff. Then you can always point to it and say "It's not just us picky SOBs in the lab who say that, it's Hospital Policy". (You don't have to tell them that you wrote it.)
 
I have to say our lab will accept some specs "in the bag" but only very specific ones (timed blood draws like drug peaks, surgical specimens) that cannot be reobtained. Someone signs an affidavit.

Under NO circumstances would I process an unlabeled sample.  It is far too dangerous, whether the standards allow it or whether they don't.

Most of the male Rh negative patients who developed anti-D in our facility only received apheresis platelets, no other blood components.

Are you using a Blood Bank computer system? If so, it could be configured to interpret weak reactivity with anti-D. Does your antisera's manufacturer direction insert address this issue? After you have done all this then I would echo Malcolm's post.
Standardization is the key to resolving these types of issues and controversies.

This is not that rare in ORTHO Gel. In 0.8% of 3500 adult plasma specimens tested from group O, A and B patients, expected anti-A and/or anti-B was not detected in the ABO Plasma Grouping test.
One of thefundamental differences between column agglutination technology and standard test tube is the use of centrifugation. In column-agglutination, centrifugation is used to separate agglutinated rbcs from unagglutinated rbcs. In standard tube, centrifugation is used to enhance the antigen-antibody reaction.
So some IgM antibodies may not react as well in 'columns' as they do in tube. I reported this in 1997 at the AABB meeting in Denver.
Our standard approach is to repeat the ABO Plasma Grouping test in test tube. This resolves 80% of the discrepancies.

Do you do an ab screen with every RhIg order?  It is not necessary for post delivery specimens.  I finally got my OB guys to not worry about an absc with an RhIg workup and it decreased my screens considerably.

I consider all of the following to be different methods: manual tube, manual gel,PEG, enzyme, solid-phase, ProVue, Galileo, Echo, Tango, Immune Rosetting Test kits, Kleihauer-Betke Staining kits.

The pick up slip is a "soft" requirement.  We do not save that  slip past 30 days.
 
The electronic order is easily reviewed under the review orders routine.  When  acknowledged by the physician, an "A" will appear in the acknowedged column.  That happens pretty quick as they are always having to acknowledge telephone orders for all sorts of things.

I would suggest that a datasheet, or something similar, is made available with, if you like, "standard reaction strengths" and, if possible, photographs of these reaction strengths (much better than drawings) and then the staff would have to follow the protocol.
Obviously, whoever is in charge would have to decide what reactions merit what strength, and then what the results should be called (i.e. positive, negative, weak, etc), just so there is some form of standardisation.

Cell #4 of ORTHO PANEL C lot# VRC203 is listed as Ror (D+C-c+E-e+). With all deference to Malcolm, do you consider Ror to have a single or double dose of the D antigen? I think D is present in a single dose on an Ror cell and that panel cell is "heterozygous" for the D antigen. Panel cells that are R1R1 or R2R2 are double dose or homozygous for the D antigen. Am I correct?
I don't think anti-D should be ruled out if cell# 4 is non-reactive but all other D positive cells are weakly-agglutinated (1+) and all D negative cells are not agglutinated.

No additional testing required. We would electronic crossmatch this patient with random units

No additional testing required. We would electronic crossmatch this patient with random units

What would you do today for a patient with a positive antibody screen and anti-e is identified, but cannot rule-out C and K?
I think you have to select e-neg, K-neg and C-neg red cells for crossmatch/transfusion regardless of the results of the antibody screen.

Using a term other than "Incompatible", comforts you and your staff and is misleading. It is the patient who makes the final decision.

Don't use the Rhophylac/RhoGAM manufacturer's forms. Also keep panel antigrams only with patient workup.
Blood Bankers should be thinking "digital storage" and optical archiving for the future!

Don't use the Rhophylac/RhoGAM manufacturer's forms. Also keep panel antigrams only with patient workup.
Blood Bankers should be thinking "digital storage" and optical archiving for the future!

What would you do today for a patient with a positive antibody screen and anti-e is identified, but cannot rule-out C and K?
I think you have to select e-neg, K-neg and C-neg red cells for crossmatch/transfusion regardless of the results of the antibody screen.

What would you do today for a patient with a positive antibody screen and anti-e is identified, but cannot rule-out C and K?
I think you have to select e-neg, K-neg and C-neg red cells for crossmatch/transfusion regardless of the results of the antibody screen.

I think the only real question for AB panel QC, no matter how it is or is not done, (or whether or not it is a waste of time), is: is it necessary per regulations? 
 
In the US, whether or not CAP or JCAHO has a specific standard on the AB panel QC issue, the key regulatory phrase for ANY Lab QC requirement is :  following the manufacturer’s instructions.  So I think all most of us need to do is check the inserts with your particular products.  If you are somehow satisfying that for recommended QC, you should be OK.
 
Scott

We use a 2-bag Helmer that is set at 36.5C.  Our timer is set for 18 minutes.  All our units are flat-frozen (200-300mL). If there is an urgent need, I check after 10 minutes and crush large chunks by hand.  We temp every thawed unit and the average temp of a non-urgent unit is 15-20C.  Urgent units are less than 15C and even less than 10C.

I've wondered about this myself, especially when we are thawing for a massive protocol and have 20 other things to do at the same time.  I would agree that 30 minutes is too long.  We usually do about 16.

A small facility doing a lot of blood banking by generalists should seriously consider an automated testing platform.  Automated testing eliminates a wide range of errors associated with specimen identification, test tube labeling/handling, results entry, results interpretation and transcription. 
 
Our platform prints a report with results and results interpretation.  We affix a barcoded sample label to the report (one patient per sheet of paper).  The barcode on the report is scanned into the LIS result entry routine and results are transcribed.  This system works 24/7/365 with a single individual wholly responsible for results entry.  I have used this system successfully over the past 10 years, both in a 525 bed Level II trauma center (>10000 rbcs transfused annually) and a 100 bed (<50% occupancy) community hospital(<1100 rbcs transfused annually).
 
I believe that any strategy that relies on double-checking a process by multiple individuals will fail.  If an individual cannot accurately transcribe results in the system described above, they should not be working in a transfusion service.
 
Blood bankers need to embrace automation in the 21st century and discard 20th century manual processes.
 
Whew!!,  I feel so much better now.  Thanks.

A small facility doing a lot of blood banking by generalists should seriously consider an automated testing platform.  Automated testing eliminates a wide range of errors associated with specimen identification, test tube labeling/handling, results entry, results interpretation and transcription. 
 
Our platform prints a report with results and results interpretation.  We affix a barcoded sample label to the report (one patient per sheet of paper).  The barcode on the report is scanned into the LIS result entry routine and results are transcribed.  This system works 24/7/365 with a single individual wholly responsible for results entry.  I have used this system successfully over the past 10 years, both in a 525 bed Level II trauma center (>10000 rbcs transfused annually) and a 100 bed (<50% occupancy) community hospital(<1100 rbcs transfused annually).
 
I believe that any strategy that relies on double-checking a process by multiple individuals will fail.  If an individual cannot accurately transcribe results in the system described above, they should not be working in a transfusion service.
 
Blood bankers need to embrace automation in the 21st century and discard 20th century manual processes.
 
Whew!!,  I feel so much better now.  Thanks.