Teristella

Have not purchased this particular product, but check out the ones available from Westcott Lab Solutions. We use their acrylic racks. http://wescottlabs.com/bldbnk/index.php

We never perform lot verification on controls. We use Alba-Chek for Vision QC.

The standards simply state "additional testing must be performed" and I had previously pointed this out to my supervisor but it never went anywhere. Their Guidelines for Antibody Identification seem to indicate that facilities can vary the frequency as long as there is a set policy, but of course the wording is pretty vague. We haven't been initially AABB inspected yet, but we'll see what happens.

All our antibody pos patients get 2 units extended crossmatched, whether there are orders or not - or 2 units in addition to any orders. Does the hospital that doesn't perform a new panel for 30 days not make you nervous?

If the screen results are the same, we don't have to perform a new ID, as long as it's been less than 10 days and it's the same admission. Any increase in screen reaction strengths requires a new ID.

Everything I am reading on that one says it targets PD-1, which doesn't look like it's expressed on red cells (obviously, I could be wrong - this is the result of a couple Google searches, I haven't opened my actual immunology book in a while!), so hopefully this one won't interfere with our testing.

New patient, no history, preopped Wednesday for diabetic-related debridement surgery yesterday. Evening shift ran the T/S specimen on ProVue as usual and encountered an ABO discrepancy; patient forwards as A pos, reverses as O (2+ A cells, 4+ B cells). The screen was edited to negative from questionable results in the last two cells. Patient cells are negative with anti-A1 lectin, although the evening shift tech did not run the patient's plasma with A2 cells (I don't think this would have mattered). The reverse was prewarmed for 45 minutes with no resolution, and, unfortunately, everything was left for us on dayshift. Long story short, repeat testing ended with us calling the ProVue screen 1+ in all cells. The gel panel produced varied results (1+ to 3+ reactions in 5 of 10 cells, which, I noticed, were all P1 positive, as were all three screening cells) with a negative autocontrol. Immediate spin results are all 3-4+, and all cells of the tube screen and both units we tried were all positive. Prewarming (1 hour) did not help. The specimen was sent to our reference laboratory and the report sent back today calls this a "cold autoantibody (strong)" but with a negative DAT (both anti-IgG and anti-C3b, C3d, negative autocontrol (gel), a positive gel screen (mixed field) and a prewarmed negative screen using an IAT technique. They recommended using a blood warmer. This is just a preliminary report - I called today and asked if they were actually able to get a clear reverse and was told they did a "settled reading" at 37ºC but that the A cells were still typing 1+. I mentioned the P1 and they tentatively indicated they would explore it before sending a final report. They sent us two units they said were compatible by a prewarmed IAT technique; only one was compatible when we prewarmed and tested with LISS today, so I tested two more from our shelf and got another compatible, per our policy. Thoughts? I am always wary of prewarm and the reference report we received was very vague and brief. The patient has a decent H/H and should not need units but I am curious what others think.

Is that collection facility standard referring to the actual product label, and not a hang tag or other type of tag?

Absolutely. In a traumatic massive transfusion especially that first round of O negs is going to waste.

I think I remember someone here saying Hemobioscience has it and it looks like perhaps that is the case? http://www.hemobioscience.com/Products/Specialist-Solutions It's listed as a 2mL liquid vial. Unfortunately I couldn't find a package insert so I'm not 100% sure, I have not used this product myself.

I have not used it, but there is a follow button at the top -- I believe that does something? I'll follow this thread to see what happens. Edit: You can have the site email you reminders that the topic exists, which I chose not to do; then if you click your name at the top, to get the dropdown to go to your profile, there's an option to 'Manage followed content' which gives a list of all followed threads. Perhaps not ideal but maybe a temporary solution?

What format is it in? Kind of odd that you cannot print it.

Washed? Yikes! Hope the patient doesn't need too much transfusion support. That would be a good refresher for staff, though, unless you are (un)lucky enough to have other patients with this requirement more than once in a blue moon.

You must have very well-trained nursing staff and very good luck, because I've had multiple occasions where the bag was just plain gone, no where to be found, so if you haven't saved a segment, what will you do your testing on? The chance of a delayed transfusion reaction, as goodchild mentioned, is the other important reason.

Anyone using this analyzer or even know of a hospital using it we might get in touch with? We were able to see somewhat of a demo today at a neighboring hospital but the vendor did not even run live samples.

Yeesh, I hope that QC madness is fixed before we have to deal with it. Knowing the VA, Ortho will have plenty of time...

In my previous position it was two techs and a supervisor (blood bank only) on days, two techs on evenings, and one at night. We were lucky enough to have dedicated weekend staff (at least, when we had a full crew), so we had one on days, one on nights and a part-time tech for an overlap from 10a-10p or so. Where I am currently there are five of us on days! Evenings and nights are covered by generalists, but we are very surgery-heavy so it works for us.

We would have done it, but they would have dug that bag out of the trash! We had a similar situation recently but it was only an hour between units. Of course in that situation they complicated things by spiking the second unit, taking vitals and deciding to report a transfusion reaction and using the DIN of the second unit for everything...

LDT (I think someone typoed above and used LTD) stands for laboratory developed test.

Definitely a dictionary problem, and I think you will find it in the product dictionary, actually. For each group, if I remember right, you can specify whether a current antibody screen is required. Perhaps someone with current access to Meditech can confirm, I'm using a different LIS now.

Anecdotal evidence, but at my previous facility we routinely modified everything to 5 day with no variances. On the other hand, the VA lab I'm at now has an FDA license number and is FDA inspected just to thaw products. I'm guessing this was a requirement for some kind of product modification they did in the past and it's just been left alone.

What do you mean by cool to the touch? You should be temping the products, if you cannot show they were at an acceptable temperature, you shouldn't be accepting them back into inventory... This is part of why we have a time limit and a temperature requirement here. Of course even if the units have been out only 10 minutes, if they are too warm we discard them, but also if they are in temp (not issued to a refrigerator or cooler) and it's been longer than the acceptable time limit, they are discarded because we can't show what happened the unit during that time frame. We temp our platelets while the courier is still here because we have had issues in the past with them being out of temp. If they aren't within the proper range they send us new ones. Edit to add: We use the transport temperature for our acceptable ranges.

Questioned this use of FFP a couple times when I was involved in transfusion appropriateness review at my previous hospital - medical director always approved it, apparently it was a valid method of treatment. Do not remember details of why, unfortunately.

Immucor's Echo has a TAT of about 25 minutes for T/S, panels and IgG XM.

Michelle, does that apply to the Emerge, or only the Courier and OnDemand systems?