Teristella

I answered the poll. We do them in blood bank (heme won't touch them) and of course the docs want them super stat because they're only done for traumas... we keep 'trying' to 'fail' the CAP survey but they make the range so wide it's basically impossible.

You should be able to add and remove things in the test profile routine, assuming there is already a D control built. Unfortunately I'm unaware of any manuals or anything, at least at our facility it seems like things such as calculations are shared within the hospital system.

We have skinny tubes too. It just takes practice. Drop your plasma for screen and reverse, and crossmatches if you want. Squeeze the pipette and insert into the tube while releasing the bulb so you pull up enough plasma to not spill any. Go nab some of the packed cells, pull the pipette out and squeeze out the cells, but not the plasma. Put the plasma back in the tube immediately and you're good to go!

We use the disposable plastic ones.

We use 6 ml K3 EDTA tubes and routinely use the packed cells for the suspension. We don't pour off the plasma for storage.

When I say we type one sample at a time, I mean from start to finish (edit: i.e. set up everything, drop patient cells, spin, read, result, move to next patient). Our sister hospital still does all manual testing and we use manual testing quite often as well. I've got no problem batching up to four samples at a time for a screen, setting up tubes for the typing and all that -- I drop all my reagents at once but I will only have one patient suspension active at a time, drop the cells and complete the typing before moving on to another patient. I'm not sure what you mean by "ABO incompatibility isn't an issue" because isn't the more important issue the fact that you have the wrong patient's sample in your hand? You wouldn't catch it -- what if you'd dropped a manual screen with the plasma from it thinking it was a different patient?

If you have the wrong sample the first time, wouldn't you have the wrong sample the second time as well? I don't really see how this helps. We shouldn't be doing blood typing on more than one sample at a time. If you did pick up two samples, what if they were both group O or group A? Really common, and you would never know you'd picked up two samples. I'd much prefer relying on a double or triple check of the label on the tube and match with the requisition I'm working on. Maybe I am still missing something!

Maybe it is just too early in the morning and I haven't had enough coffee, but I am not understanding what you're trying to accomplish here. What do you mean by "lab generated" wrong blood in tube and how does spinning the sample twice help prevent that?

Yes, part of our mass casualty procedure includes someone from the blood bank managing the blood in the trauma bay/ED. We send them with a cooler of blood (mostly O pos, a few O neg, unless the situation calls for more O negs for whatever reason) and a cooler of plasma and we have a form where they can put a sticker from the unit and the patient's trauma name. Unfortunately with plasmas they'd have to write the unit number as ours don't come with DIN stickers on the back. We'd handle getting them platelets on an as-needed basis, and it would just work the same way. Luckily so far we've just had a day where 13 traumas came in back to back, and four or five were bleeding. In that situation we triaged blood product issue in the trauma bay like this, but most patients ended up moving to the ICU or OR fairly quickly, so we could issue from the blood bank to those patients quite soon and eliminate a lot of the confusion.

Henshaw (He/MNS6) is listed in the Blood Group Antigen Facts Book, but there isn't any data about clinical significance. It just says human anti-He is rare.

For blood/plasma, we don't do it, unless it's going to a bedside procedure of some sort (exchange transfusion), or dialysis, and it goes in a cooler then. We will, however, issue two units of platelets at once, providing the nurse has orders to give both and they will be given back to back or at the same time. We rarely have requests for this except from oncology nurses we see every day who are extremely familiar with transfusion, and we've never had a problem with them. If I wasn't familiar with the nurse, I wouldn't do it.

Ah, yes, I should mention that when we went live with this last year, our blood supplier made segs for us on the first 200 units of liquid plasma we received and we did titers -- more than 80% were <64, if I remember correctly. We also log all patients who receive emergency release blood at our hospital, largely so we can do chart audits to make sure the emergency release form makes it onto the file, signed, but also so that we can catch the rare B and AB patients who receive group A plasma. If those patients survive long enough, we wait until the massive transfusion is over and draw some fresh samples for a DAT, hepatic panel, and we always do free anti-A testing before switching them over to B or AB units. We've not collected much data from that simply due to the fact that B and AB patients are fairly rare and about half passed during the MTP simply due to the nature of their injuries.

We keep two AB thawed plasma for regular emergency release and pediatric traumas, but for any other traumas, or in the case of a massive transfusion in OR or on the floor, we use all A plasma. We use those when they get short on any patient and put a note for night shift to thaw two more after midnight so we get an extra day on the replacements. We keep between 6 and 12 liquid plasma (never frozen, 26 day expiration) to be stored in our trauma bay refrigerator and in our blood bank refrigerator, so they have a couple of batches (we do 6 PC, 6 FFP per batch, with a platelet every other batch) ready immediately in most situations. After that, we thaw A plasma and give O packed cells. We find that the easiest thing for us to do is stick to O packed cells and A plasma throughout the MTP -- we have plenty of those types available and in the event that there are multiple bleeders at once, IF a cooler gets switched, there's less risk.

Well, we use Immucor's Panocell products and the insert says that QC "may" be performed. I think we'll stick with our current process of only QCing expired panels if we need to use them, at least for now!

We don't QC panels unless they are expired. If they are quoting the standard above, I'd point out that antibody detection methods are QC'd, since we do daily rack QC (or ECHO, or gel). That standard says nothing about antibody identification.

Here's a quick link to the FDA page regarding it with the guidelines. It includes this verbage in section B. "What Do I Report? (21 CFR 606.171() Under 21 CFR 606.171(, you must report any event and any information relevant to the event associated with the manufacturing, to include testing, processing, packing, labeling, or storage, or with the holding or distribution, of both licensed and unlicensed blood or blood components, including Source Plasma, if that event meets all the following criteria: Either Represents a deviation from current good manufacturing practice, applicable regulations, applicable standards, or established specifications that may affect the safety, purity, or potency of that product; or Represents an unexpected or unforeseeable event that may affect the safety, purity, or potency of that product; and Occurs in your facility or a facility under contract with you; and Involves a distributed blood or blood component.An adequate procedure for deviation reporting (21 CFR 606 . 100() would include steps for determining whether or not an event is one for which a report must be submitted. The decision to report should be based on whether the event had the potential to affect the safety, purity, or potency of a product. The terms safety, purity, and potency are defined in 21 CFR 600.3(p), ®, and (s), respectively." Better safe than sorry! The most time consuming part for us was logging all the unit numbers from the freezer.

I wouldn't discard out of hand. We had a similar situation where we were temporarily storing frozen products in a freezer that did not have continuous monitoring and a tech reported a temp of -17C. Our supervisor submitted a biologic deviation report to CBER/FDA and we were able to use the products, which were obviously still frozen. I would quarantine everything and check into this with the FDA -- while your products were a bit warmer than ours I would say that -12C should still be pretty frozen. I believe that we quarantined until the report was reviewed and the products were released. Seems a shame to toss everything without looking into it.

I don't believe AuntiS meant to give antigen negative if the patient was positve for those antigens, but rather if cells weren't available to rule the antibodies out. That is our practice too, especially with the C, considering most units that are e negative will also be C negative. If the patient is K positive we would not of course not worry about giving K negative units.

The same happened to us over last weekend. Techs having tons of problem with false positive results on RS lot 547. They sent service out and replaced a couple parts but the problem continued. They had sent one box of another lot (553) which seemed fine, so we called and had them replace our entire batch with that lot. Our Ready ID lot right now (ID241) is completely worthless, a couple of techs are calling the random ?, 1+ and 2+ results 'warm autos' and sending to reference lab. Think we need some re-training! We try to go straight to Extend I or II depending on the situation and have no issues.

We have transitioned to using group A FFP and liquid plasma for our trauma patients who are emergency released blood, and for all MTPs (we still use AB if we have an abundance of it thawed or if we are only able to get AB liquids to restock). My supervisor worked with the trauma program medical director and the CMO and we developed new SOPs for this. We have discussed putting together a short paper, as we've been collecting data on all emergency release patients. Since September we've had about 40 trauma patients receive group A plasma, and we've only had three B/AB patients in that group. On each of these patients we ran some extra post-transfusion labs (renal panel and LDH, DAT), nothing really notable so far. We've also been doing an abbreviated titer on the liquid plasma units we receive and setting aside anything with a titer of 64 or greater (only about 10%) for use on A or O patients only, if possible (which is most patients anyway!). FFP is not titered. So far we've had no problems and it's been much less stressful than trying to restock AB after multiple traumas. In fact we had a day last month where we had 7 bleeding traumas in one shift, we would have been in a pickle if we'd used AB for them, so it was a huge help.

That's one way to do it! Unfortunately I guess the issue with ours is there aren't enough ducts into the lab, so they will have to do some major work to fix it. Meanwhile we're currently dealing with construction as they build a fancy new consolidated ICU wing and add beds here and at our sister hospital and we've been asked to take on adding two blood bank-managed TEG analyzers. No idea where we are going to put them! Should not, or cannot? We store everything in one refrigerator at our sister hospital due to space issues. I'm just a lowly tech, is there a reg I don't know about referring to this? I understand it's ideal to keep them separated, but we've never been cited by CAP. Everything is on separate, labeled shelves.

For us, acceptable room temp is 18-26C. Our antigen typing sera package inserts indicate room temp testing should be done at 23C +/- 3C, so this is why. We have been lucky so far, our blood bank is crammed into a tiny room with inadequate air conditioning and temps routinely rise to 25C easily, and have gone as high as 26.4C. We just have to watch what we are testing at the time and be careful not to keep units out for any length of time, and hope that they can get us some more air.

You can log in to the customer center (top right) at http://www.immucor.com/. They have master lists there for you to download. Something this old is kept in their archive folders. You can always call and they can email or fax it to you as well, I'm sure. I'm attaching the pdf for that lot number (the second file is the supplemental typings on the back). Hope this helps! Panocell 10 53129.pdf Panocell 10 SUT 53129.pdf

This is how our system is set up. It works well for us.

A bit of a rant -- I'm surprised no one else has posted about this yet -- our last batch of screen cells from Immucor had a Wra+ cell and we have been PLAGUED with nuisance positives as a result. Called and complained and they sent us two sets, but we went through those already. They only have four days left on them so we're just sucking it up and trying to run everything we can on Echo (even more than usual, I try to run pairs and this month I've run a lot of single samples to avoid delays from a possible anti-Wra!). We found 4 in three shifts after opening them which was what prompted us to call. Who knew how common anti-Wra was (or wanted to know?!) If it happens again I think we'll insist on the whole lot being replaced. We generally run traumas on the bench and had quite a few with anti-Wras, the docs tend to get nervous when the screen is positive and we're still ruling out majors!