Teristella

Remember that anti-E can often be naturally-occuring. I would say that is probably the most likely situation in this case, but regardless we would give R1R1 units at our facility.

We issue blood each morning to a remote refrigerator in our outpatient infusion center. The center is in the same building as our blood bank, but it is minimally staffed so they cannot come pick up blood on each patient as they need them. You are definitely going to have to have some considerable trust in your infusion staff if you do this in the same manner we are, as the units are issued in Meditech in the morning and we know they will be transfused to the correct patient only (they are VERY adamant that they will not transfuse blood if anything is incorrect or questionable), and if something happens they let us know and we pick up any untransfused blood as soon as possible, and it does not stay there after hours. If the patients need platelets, we deliver them as they are needed because they do not have a monitored platelet rocker there. As far as the Pyxis-like fridge -- we also have a Haemonetics blood kiosk in our trauma bay for emergency release/MTP products -- I know Haemonetics offers a system that allows nurses to scan a 'pick up slip' for their patient, then open the fridge and remove a crossmatched unit that was pre-loaded by blood bank and scan the unit label. That might be an option for you.

We do selected cells. We have quite a few recurring patients come through our outpatient infusion center and a number of them have developed antibodies.

We use the syringe sets from BD. I am not sure how their price compares to other available products. We do not have OB though, we only keep them for the occasions where we get babies as trauma patients, so the cost is not a big concern.

In my past life as a reference lab tech we would routinely phenotype new donors this way. We used the same procedure as David above. Saved us a lot of time finding the full phenotypes of multiple donors (we used plate testing to screen large batches for little c and little e negative units and would complete phenotype in gel). Write up a procedure and do a validation comparing results in tube to results in gel and you should be fine. The number of samples you choose to run is really up to you, but as someone said above, it would be a good idea to run some heterozygous samples.

We have that problem with filing paperwork! If I leave it with a polite sticky note at the end of my shift, it will sit through both evening and nightshift untouched.

My most commonly occurring pet peeves: -- When techs who answer the phone spout off incorrect information -- such as "if we order these irradiated platelets for you routine you will have them this afternoon around 4 or 5" (our evening courier comes at 9 p.m. at the earliest!) -- Ignoring patient samples, especially STATs, to do things like bring in inventory, review transfusion data, etc. -- Not asking the right questions! I am fine with being called at home but last weekend had a tech call to ask what to do about an incompatible crossmatch (maybe... don't give the unit? Negative screen/panel -- plenty of stock available -- leave unit number and a note for supervisor...), but same tech didn't call about a questionable workup -- we almost missed a new antibody because they wanted to call it 'Echo junk'. If that Echo junk looks suspisciously like an anti-c, it might be an anti-c... -- Leaving things in weird places in the fridge with no note/explanation. I get to be a detective 2-3 mornings a week because people just forget, I guess.

Our issue screen in Meditech has a field that says "Physician Order/Consent Verified" and this links to the nursing module. The nurses are required to enter pre-transfusion vitals into a checklist, as well as answer a series of questions, including whether they have an order to transfuse, patient has been educated and consented, IV is patent, etc. If they have finished all of this, the field automatically fills with "Yes" for us, so we have 'proof' that they say they have a transfusion order. This is pretty new for us, we have been educating nurses that they will be turned away in a couple of months if this is not completed (except for OR, trauma, and emergent patients in ED, of course). At least this way nursing indicates to us they have done everything they need to do before picking up a unit. We were very in favor of having a pickup slip where nursing had to sign that they had done all of these things, plus note the patient's current relevent lab values, but administration did not want any additional paperwork. We were planning to use these for transfusion appropriateness monitoring too. Can't win 'em all I guess.

The new Helmer freezers/refrigerators with this feature use a Peltier-based probe test that physically heats/cools the probe, so it is actually a change in probe temperature, not just an electronic simulation. I am not sure about other brands. That being said, we do both at our facility quarterly. The manual test is not that time consuming.

We do not have anything reflexed. When a patient with no historical type comes in, we attempt to locate a second sample in chem/heme. If we find one, we add a test we designed for this purpose (just a forward BT) to the patient's TS req. There isn't a charge associated with it, it only counts for 'number' purposes for us, but every little bit helps there! We result that using the second specimen. If the patient types as O (or AB for plasma), we don't bother. If we cannot locate a second specimen our actions depend on the situation. If packed cells/plasma are ordered we can either order the retype test and have labels print for a phleb to draw the patient again, or we do not order the test and give group O/AB if the situation is emergent. If no products are ordered we make a note that 'confirmation is needed' and basically wait it out to see if by the time products are ordered we will have another sample. Most of our patients either have a HX or type as O. For pre-ops, most of the time the blood is not transfused anyway, so we do not hesitate to set up group O even if they are another blood type. If, on the day of surgery, they bleed, we should by then have another sample and can switch to type specific.

We also use Meditech. We have it set up so that units brought into inventory default to 'entered' status and a unit blood type specimen is created/ordred. Once that blood type is resulted and verified the unit switches to 'available' status. We cannot crossmatch/assign/issue units unless they are at 'available' status. We retype units when they are brought in, and we pull our seg to save at that time as well. We do not use any stickers or anything on the unit to show that it has been retyped, they are always retyped before they are placed in stands on the stock shelves. Unfortunately I cannot help you much with the Meditech setup, but hopefully this gives you some ideas.

I used to work for a blood center reference lab and we were not be able to use rare units that we 'lost' this way. We made a very huge effort to go label freshly collected units every day with 'RARE - please filter' tags but if they were not caught before the 5 days, we could not have them leukoreduced.

Our docs want 1:1. We do 6RBC, 6FFP and a platelet, then a second batch of that with no platelet, then a third batch that is 4RBC, 4FFP and another platelet and cryo, if requested. Then back to the first batch.

Saw this in my blood bank. ID'd an anti-K in a trauma patient, who then received two K-neg units, crossmatch-compatible with PeG (our main method at the time). About a week later, new type and screen is submitted and we ID an anti-K and now an anti-Jka, and DAT is weakly positive. I did a workup -- repeated the old panel with ficin (lucky we had run the Immucor Panocell-10 w/ficin-treated originally!), only anti-K demonstrating in previous sample. Crossmatched the two units transfused, compatible with old sample, one was heterozygous for Kidds and was incompatible with new sample. Eluate positive for anti-Jka.