kirkaw

I have a question about the ID-Tipmaster, which I think is the old version of the Biohit. The package insert says it is beneficial to clean and grease the plunger periodically. But it does not say how to do this or what material to use to grease it with. Does any one know? Thanks!

I like the BBGuy transfusion reaction charg. I use it quite often and used some verbiage for one of my policy.

I agree with R1R2. Our policy is the same as Justina's and KAPMT. I am meeting with my boss this week to discuss a quality project on this very issue. We have many doctors who do not look for completed Type and Screen and crossmatch orders and order unnecessary tests and blood products all the time.

You all may be interested to know that our medical director decided to document this in our deviation from standard practice book and not to chase down a signature on the emergency release form.

Thanks Malcolm...as always...very helpful.

If blood is emergency released but all of it comes back and none is infused, is it necessary to keep the emergency release form signed by the ordering physician? Thanks!

Malcom and R1R2, are you saying that anti-V is not clinically significant and Coombs crossmatch compatible blood is OK? We have a patient in whom our reference lab has identified anti-V and we have been ordering V negative blood. Is that necessary?

Many have stated that more blood products cannot be issued before the transfusion reaction investigation is complete. How do you define that endpoint? Is it when the workup is done serologically (including clerical check) and there is no evidence of hemolysis? Or do you define the endpoint as when the blood bank medical director signs off?

Thanks everyone! I had not thought of this tactic. I will do as David suggested. Thanks again. Amelia

I agree with Terri. We accept the date on the lab accession labels on blood bank tubes. We do not require phlebotomists to handwrite the date. We are not CAP accredited either, but this is fine according to our last AABB inspector.

This question was addressed specifically at the 2013 'Ask the Standards Committee' session at the AABB annual conference. The word was that it is NOT necessary to reconfirm antigen typings performed by an IRL. They did not mention a CAP standard, only that this is unnecessary for AABB purposes.

Our biomedical engineering department puts stickers with unique numbers, called asset tags, on all testing equipment. That's how we track ours.

Greetings, We use the Ortho Confidence system to QC our wet reagents. I have been alerted that there will be a delay in the next lot number shipment due to the (US) government shutdown. The current lot that we are using expires 10/29/2013 and the new lot # is set to ship on 10/30/2013. My question is, can I use patient samples that have established values for QC testing for the couple of days that I am without unexpired QC material? If so, how many examples of a particular value do I have to have in order for it to be a valid QC evaluation? For instance, if I want to use a group A patient to QC the anti-A reagent, how many times does that patients blood group have to have been tested? Thanks for the input.

Has anyone used the Sahara III plasma thawer by Sarstedt? It uses convection heat and a warming plate to thaw the plasma. It includes a sensor that lets you know when the plasma is free of ice. I had it demo'ed in Oct. of last year and fell in love with it. The unit is small, easy to clean and I love the concept. I called 3 references and they were very complimentary, so I ordered one for a new facility that we are opening. The unit was shipped promptly...so far, so good, right? Now that we are testing, I'm not so happy. Despite the fact that the manual says that it should take 15 min. to thaw 1 unit of plasma, we are finding that it takes 30 to 40 min! To thaw 2 at a time takes 40 to 50 min! I am very unhappy with it's performance. Additionally, sometimes the audible beep alarms when the plasma unit is free of ice and sometimes it doesn't. I am very interested to know if anyone else has experience with this peice of equipment. I'm beginning to wonder if we are doing something wrong. Thanks, Amelia

Can anyone tell me if it is required by FDA/AABB/JCAHO to record the temperature reading from a chart on your refrigeration units daily? Or is it sufficient to keep the tracing? Thanks

I would like to re-visit this issue. We have been told that we cannot affix anything to the outside of the cooler that cannot be cleaned, so no tape or paper. I would like to know what, if any, information is required on the outside of a blood transport cooler and the citation of that requirement, whether it be AABB (which Standard), Joint Commission, CAP or FDA. Thanks, Amelia

Malcolm, I am not certain how to answer your question. I would not venture to contradict a person as experienced as yourself. We do not see a large population of patients with WAIHA who are repeat blood users. If/when we have a WAIHA patient who requires transfusion support over many days time, we would assess each sample. If the reactivity showed marked increase in strength, we would definitely send it out for work-up each time. We do not have the resources to do adsorptions at my facility. If however, the reactivity was similar in strength and IF we had the ability to give phenotypically matched red cells, we would do that as opposed to having the sample worked up again. I have heard of some institutions doing adsorptions every 7 days instead of every 10 days but we do not have a specific policy to this nature. I guess if this ever comes up, I would consult our medical director. My original comment regarding not working up a specimen for a WAIHA patient who had received phenotypically matched red cells stemmed from a consult I received from a trusted blood banker who said her preference is to give phenotypically matched red cells and never doing another adsorption unlessthe patient has a difficult phenotype, a reliable phenotype could not be ascertained or the patient had a transfusion reaction.

Although we do not do this at my current hospital, I have worked at a hospital that used phenotypically matched red cells for sickle cell patients. In my current hospital, if we have a WAIHA patient for whom we can get an accurate phenotype, we do typically give them phenotypically matched red cells. this makes it easier upon subsequent admission. We know that we have not given the patient any cells with antigens to which they could make antibodies, so if they have a panagglutinin in their serum, we don't have to do the complete work-up again.

I do not remember the ethnicity of this patient, but it very well could've been an African American. As for the cardiac surgery being a heart transplant, the answer is no. We do not do transplants here.

Our pre-op specimens are good for 28 days. The question as to whether the patient has been pregnant or transfused in the past 3 months is asked by the pre-op nurse during the pre-op interview and is documented in that database. We rely on Nursing to ask and document this information. We do not get a hard copy of the answer. Anyone other than pre-op patients, whether they are inpatients or outpatients, regardless of transfusion/pregnancy history, have specimens that outdate in 3 days.

We get all leukoreduced RBC units as well. I do not think you can use washing and leukoreduction filtering interchangeably.

We do types and screens on OB patients on admission and get information about RhIg prophylaxis from the nursing staff if the patient is Rh neg with a positive antibody screen. If the answer is yes, we do not do any further work-up and if the patient needs red cells, we do a Coombs crossmatch. Only if the Coombs crossmatch is incompatible, do we go back and investigate what other antibodies might be present in the mom's plasma. But here's another question. If a woman has a preadmit appointment prior to a scheduled C-Section, do you ascertain whether or not she got prophylactic RhIg? We have had 2 cases this week where we had a terrible time getting this question answered. As in, it took hours for the doctor's office to call us back. It turned out that both of these women had allo-anti-D. Which brings me to my 2nd question. If you discover that a pregnant woman (about to deliver) or recently delivered has allo-anti-D, what do you do next? Titer, even though you have no baseline? In both cases, we opted not to titer but to evaluate the infant upon delivery.

I am a bit confused by the AABB buletin. Am I correct in thinking that they are recommending testing of all platelet products within 24 hours of transfusion, including closed-system apheresis platelets? In looking at the product information on the Verax website, it appears that it uses a 500 uL sample of the product. How do you get the sample without creating an open system? Is anyone willing to share what the Verax system costs? Thanks!

The patient's admitting diagnosis was septicemia but he acutally had heart surgery. I don't know the intervening issues or procedures. In Jan. he was in the medical ICU with some sort of respiratory issue. I only know that he was on a pulmonology service. A blood banker friend of mine suggested that I treat the patient's cells with EGA and then run the eluate and the plasma against the treated cells to determine if the antibody was auto or allo. I will try running against cord cells too, if I can find some with the suggested phenotype. We don't keeps such things on hand. Thanks for the input.

If you have the 17th edition of the AABB Technical Manual, look on pages 448-450. It's the chapter on Pretransfusion testing and explains the different enhancement media and how they work.