kirkaw

We had been using an arbitrary 14 days if not pregnant or transfused, but recently expanded to 21 days or the OR's request - too many redraws. I think the only limit is your own comfort zone and storage space for specimens for serologic crossmatches and/or keeping them for a week post-transfusion.
 
If you perform serologic crossmatches and transfer your serum/plasma to an aliquot tube while doing your T&S, I have noticed that once in a while there will be a turbid layer of microbial growth in the aliquot tube after several days' storage.
 
Our LIS electronic crossmatch requires an antibody screen within 72 hours but this can be overridden.

I think yes, you trust the negative antibody screen. This is what we do every day. When we get a negative antibody screen, we don't run cells positive for low frequency antigens just in case, even though we don't know if the patient has been transfused and may have an antibody titer that has fallen to undetectable levels. That is what the Coombs crossmatch is for. If you get an incompatible crossmatch, you would do more investigation to find out why

I would not repeat the panel in either case unless the C negative, AHG crossmatched units were incompatible OR the antibody screen showed additional reactivity or increased strength.

Assuming that the serofuges in question refer to ones used for pre-transfusion testing of patient specimens, I would not report this to the FDA. FDA reportable events are ones that may have affected the safety, purity or potency of a distributed blood product. This applies both to transfused products and products that were in control of the BB/TS at the time of the deviation. I do not think your situation applies. Granted, the safety, purity or potency of the product may have been affected if you mistyped a patient due to improper centrifugation, but I think that's a stretch.

Unless things have changed in the past 6 or 7 years, and they probably have, the AABB Standards addresses this quite nicely and when we adjusted our policy to match it more than a few blood bankers in the corporation were convinced that we would have patients dying right and left from transfusion reactions.  I'm sorry that I can't come up with the exact standard but if memory serves it was very close to what David and pbaker do. 
Basically, if I recall correctly, the standard essentially said that once the antibody was ID'd any follow up testing only required enough testing to indicate that no new antibodies had decided to show up.  We interpreted this to mean that the antibody screen (3 cells) still indicated only the anti -  C was showing (hijacking the example above) and all C negative units were AHG compatible.  The theory was that the AHG crossmatch would catch any significant antibodies the antibody screen missed.

I have included in my antibody identification procedure, verbiage almost identical to what is listed in the Immucor package insert for panel cells. It's somewhat vague. Our JC inspectors suggested that the reason for doing QC on panel cells was to be in compliance with the manufacturer's instructions; they did NOT say it was a JC standard. I personally, think QC'ing panel cells is rubbish. I've been working in BB/TS for 25 years and this has never come up before. One argument I've heard is that it is impossible to verify the potency of the cell based on 1 antigen. If you were truly testing the quality of the cell, you'd have to test for every antigen.

Mari, I am so sorry for the tragedy that your community had to endure. I'm sure you and your staff behaved heroically. I'm sure most of us have practiced disaster drills/emergency preparedness drills many times hoping never to have to use those plans. Might I inquire how well your emergency preparedness plan worked? Do you have any words of wisdom for revising such a plan given your real life experience?

Do you have a copy of the Technical manual, 16th, 17th, or 18th edition? This discussion can be found under Chapter 16: Identification of antibodies to red cell antigens. Under the section titled 'Probability.' Table 16-3 shows a breakdown of p values based on different mixes of positive/negative and different statistical methods. Our procedure looks for at least two reactive & two nonreactive.

Given that almost all of these "auto-anti-E" and "auto-anti-e" antibodies are mimicking specificities, and that the quoted "auto-anti-E" and "auto-anti-e" are actually "auto-anti-E-like" and "auto-anti-e-like" specificities (but NO Reference Laboratory is going to prove this nowadays by using extremely rare red cells [why re-invent the wheel], including mine, and the IBGRL [and, I would suggest, that run by George Garratty]), it is safe to ignore these auto-antibodies, unless antigen positive blood (i.e. E+ or e+) suddenly become so short-lived after transfusion that they are no longer an option. Most of what you are seeing are either anti-Rh17 or anti-Rh18 - and you are NOT going to find units that are negative for these antigens, except in frozen rare blood banks.
Do not worry. Give antigen positive blood, if the individual needs blood.

We would not try to find any additional cells in this case, UNLESS there was some unexplained reaction on the panel that did not fit the Fya pattern, (i.e., a Fya negative cell reacted positive and it was Jsa positive.), or the AHG crossmatch showed reactivity with a Fya negative unit.
We treat V, Cw, Jsa, Kpa and Lua this way.

We always run a screen.  First, for the reason Malcolm mentioned.  Also, in the case of some antibodies, the titer may have dropped to nothing over time, in which case a panel may be a waste of time.
 
And besides, you may have a few more cells to use along with the panel to finish rule-outs!
 
Scott

We do not issue multiple RBC units for non-emergency transfusion unless the units can be infused simultaneously, i.e., more than one existing IV line.

I have included in my antibody identification procedure, verbiage almost identical to what is listed in the Immucor package insert for panel cells. It's somewhat vague. Our JC inspectors suggested that the reason for doing QC on panel cells was to be in compliance with the manufacturer's instructions; they did NOT say it was a JC standard. I personally, think QC'ing panel cells is rubbish. I've been working in BB/TS for 25 years and this has never come up before. One argument I've heard is that it is impossible to verify the potency of the cell based on 1 antigen. If you were truly testing the quality of the cell, you'd have to test for every antigen.

I have included in my antibody identification procedure, verbiage almost identical to what is listed in the Immucor package insert for panel cells. It's somewhat vague. Our JC inspectors suggested that the reason for doing QC on panel cells was to be in compliance with the manufacturer's instructions; they did NOT say it was a JC standard. I personally, think QC'ing panel cells is rubbish. I've been working in BB/TS for 25 years and this has never come up before. One argument I've heard is that it is impossible to verify the potency of the cell based on 1 antigen. If you were truly testing the quality of the cell, you'd have to test for every antigen.

Other than the obvious (maintaining the highest quality standards):
1. Better, not just more rigorous, inspections. The assessors are trained and are required to do continuing education. It is a more process-improvement type of assessment, instead of just getting through a checklist.
2. Access to AABB services (publications, etc) at a reduced rate.
3. Networking with other BB professionals. Using consultation services if needed.
4. Discount for annual meeting. Yes, it's that good...ask if your hospital would pay or reimburse for at least part of this.
5. Support for Patient Blood Management.
Also, the Joint Commission uses AABB standards, so if you are already maintaining your standards, you should stay accredited to get the benefits of belonging to AABB.

Ah yes - Having had to put up with all sorts of ??? over the years, now we have the real stuff. Just keep it away from the fan!!!!!

I would send them to Microbiology every time.  As you quite correctly say, they are the people who are trained in this area.

we do everything except post screen, XM and UA. We continue to use pre sample unless something is found in the post.   

Scott, I think that the phrase "Apples and Oranges" applies here.  Probably even better would be, "Apples and Potatoes".  Even apples and oranges are both fruit.

Being able to respond to an inspector's inquiry for evidence that patients identified as candidates for Rh Immune Globulin and verify the injection is essential to the process, whomever dispensed it whether Blood Bank or Pharmacy. If your process can accomplish this, it shouldn't matter which department dispensed it.

Actually it is a blood derivative.
In the USofA blood is considered a drug by the FDA - to get better remuneration for his staff one of my previous lab mgrs had all the blood bank staff assigned to the same pay scale as the pharmacists - pretty ingenious I thought.

This is getting a little ridiculous.  With good controls showing the antigen is still reactive (either the pt or antigen reagents), expired panels should be OK to use for additional ruleouts only, as we have done for decades.  You don't use them for the initial work, but ruleouts surely are OK? 
 
Haven't we recently had several discussions on how to do controls on these older panels just for this use - and now we can't use them at all???  I am only able to keep one panel on site at a time - that is not always going to allow for all ruleouts.  We keep our panels for up to 3 months only and run a positive control on the panel to show the antigen being tested for is still detectable. 
 
CAP did have a specific standard that allowed an exception for the use of RARE antigen typing reagents only (the really expensive ones) that passed controls on day of use.  TJC does not have that same exemption and I have wondered what they would do with Blood Bank reagents.  Doesn't sound encouraging.  We will be inspected by TJC this year (our 2nd time), so I guess I will find out.
 
None of the rest of our routine reagents are expired and we do not use expired RBC reagents either for routine testing.

All though this is a wonderful idea in theory - in practice it could result in the accidental electronic issue of a clinically significant antibody. Take away the failsafe and you risk an error. We insist on full crossmatch for any new or historic antibody regardless of whether it is demonstratable or significant. It's no biggie in terms of workload - after all we used to crossmatch everything...

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.

To play the devil's advocate here: The infraction itself doesn't violate the CFR, it is not in compliance with your policy and procedure, which to me, would be of more interest to CAP/AABB or Joint Commission. The question is, does the omission of the immediate spin crossmatch adversely affect the safety, purity, or potency of the transfused products. What method of Coombs crossmatching is being performed?
 
We have both a computer truth table that prevents the selection of ABO incompatible units and we did a validation study to show that gel technology does detect ABO incompatibility; therefore, we have deleted the immediate spin crossmatch when a Coombs/gel crossmatch is performed. BUT, this is NOT in violation of our policy and procedure.