kirkaw

I would agree that there is no correlation between the strength of the DAT and the severity of the HDFN (ABO HDFN quite often has a negative DAT), but I would thoroughly disagree with the comment that a weak DAT means that there was a smaller foetal bleed.  There is very little correlation between the amount of the foetal bleed and the strength of the maternal antibody.  There is much more correlation between the immunogenisity of the foetal antigen and the strength of the maternal antibody.

We do do 'live' transfusion audits, but I agree with Kate, that I do not think this is mandated by AABB standard 8.2. I too find, that my nurses are 100% compliant. Our current audit process involves following transfusion practice from blood (specimen) collection, through testing and transfusion. I have a form that I use to check off each step.
However, I attended the AABB annual conference and went to a wonderful seminar on internal and external audits. One thing they pointed out, was to check all QC and inventory records from the day of the transfusion that is being audited. We haven't ever checked everything that could have affected the transfusion. The advice was, if you have 100% compliance then either the audi is not effective or you are missing something.
There was also talk about having a variety of audits and a schedule of audits that is approved by the medical director. I plan on trying to revamp our quality assurance program to include audits on adverse events, on suppliers and on transfusions adhering to (or not adhering to) the institutions transfusion guidelines.

I managed to talk my way out of 4 non-comformancies at my first audit. If you know your stuff and you can explain to them why they are wrong, you can get it dropped on the spot. You do have to be good at debate though...
 
My idiot one was they complained that we hadn't validated the boxes we were using. We had been using temperature loggers in the boxes for 2 years, documenting the temperature every 5 minutes and argued the fact that there had only been one failure in 2 years (due to the air con on the van breaking down when the temps were at minus 16 and them getting stuck in snow for 10 hours) that it was a self validating system. We compromised and I agreed to rotate the boxes to a shedule to ensure they were getting monitored equally. I suppose they had to pull us for something...
 
I would argue in this case that comparing a technology detecting IgA and one detecting IgG is like comparing a platelet count to a FBC - lunacy!

 
I was actually tempted to say this! 

Have used Meditech, Sunquest, Cerner, HCLL.....of those:
1. Think Meditech may be great for Donor Facilities; but it is probably the most difficult system I have ever used
in the Transfusion Service!
2. Love HCLL for the Blood Bank
3. Don't like Sunquest for the Blood Bank.....used in a lot of places because the "whole" Lab is on the same system;
and it may be great for other depts.; but not my favorite for the Blood Bank.
4. Have not used Cerner Millineum so don't know about that.....original Cerner was fine.
5. Last place I worked used Softbank for the rest of the Lab and HCLL for Blood Bank. There was talk of switching
Blood Bank to Softlab; but since didn't occur when I was there, I cannot comment on it (but would have fought to
keep HCLL because I liked it so much). Very user-frienly in the Blood Bank environment; can almost "figure it
out" without being taught.
Brenda Hutson

Mabel - I'm glad I'm not the only one who feels that way about McKesson products.

For me a no brainer - September 30th or 6 months, whichever is the earliest.  Not a question of CAP or anything else, just common sense
So, you make up the solution on January 1st - you can use it till July 1st
You make up the solution on May 1st - you can use it till September 30th
You make up the solution on July 1st - you can use it till September 30th
 
Unless (which I doubt) it specifically says otherwise in the accompanying box insert (IFU)

For pre-op specimens obtained >72 hours prior to surgery, we document that the patient has not been pregnant nor transfused in the past 3 months. That is the only specimen we get pre-operatively, even if the patient has an antibody. When the patient is admitted, we use that same pre-op specimen for crossmatching. Once the patient is transfused, the pre-op specimen becomes subject to the 72 hour rule.

My opinion - if it is within your timeframe for an acceptable preop specimen and you feel certain the pt has not been transfused since your previous specimen there is no need to send off another reference request.  Besides, you are going to be doing an antiglobulin xm with the new spec so - - - should be no problems.

We also do this, but not in response to 8.2.
I think your assessor interpreted the standard.  It does not state that you need to observe.
You need an audit for 'patient identification' but that also includes specimen collection.  'Blood admin policies' need to be audited.
If you have a way to effectively audit all the points listed in 8.2, then I would say that you meet the standard.

I agree totally with Malcolm.  The decision as to whetehr or not to perform an eluate should not depend on the strength of the DAT but on the reason you were doing the DAT in the first place.  A +/- result after a transfusion - yes.  A 2+ on a non-transfused patient who always has a 2+DAT because he's on some sort of medication that causes this - no.

Well Karrieb61, you are correct in knowing my opinion on microscopic reading of ANYTHING to do with blood transfusion (with the obvious exception of a Kleihauer), but, if the DAT is positive, and there has been a transfusion within the last three months (unless the DAT was positive before the transfusion and has not got stronger since the last transfusion), I would perform an eluate - UNLESS, the patient has an auto-antibody, in which case it is a complete and utter waste of time.
 
It sort of depends upon the circumstances - but certainly not every time you have a sample.

Should means recommended; Must means do it.

Aafrin - I don't mean that. If the plasma is left on the thawer (at 38oC) for an hour and a half is it classed as 'cooked'? If so, how long over the thaw time is considered acceptable? If not, how long can it stay on the thawer before it needs to be wasted.
 
We threw the bags away - unfortunately they were 2 MB treated ones priced at £180...

On a slightly different note David, I found while doing work review, that a tech had accidentally used expired antisera. Her controls worked. I assumed that this should result in a BPDR even though the controls worked. Am I wrong about that? Thanks!

Thank you for all of the input.  The patient was transferred to hospice care today.  I will keep all of your answers in mind for when this comes up again (since I'm sure it will).  
I was in the reference lab for 10 years (do all you can to get an answer), so I'm still adjusting to the hospital setting (do what is necessary to get safe blood, cost-effectively).  

Our blood bank policy is if there has not been a transfusion in 3 months we would not do the elution.  Granted if you do not have any previous history on the patient you are relying on their word, but its not like you are asking if they took a certain medication that they may or may not remember.  Most patients, will remember if they received a transfusion or not.
 
Now I have some older techs that will still run one to see, and if we have a patient that looks to be a WARM auto we will run one, but in general we don't unless proof of transfusion
 
But there is a small possibility that you have bad intel as goodchild said and you may miss something.  Kind of a judgement call.

Zip! Our pathologist does not have a strong BB background so I think he knows his limits. We have a Trans. Medicine medical consultant available to us for those problem identification issues as well as a Reference lab close by too as backup. But the part-time Pathologist we have does not get involved.

Our pathologist does not have input in the identification of antibodies and they do not review the records after.  Significant/insignificant is made by the supervisor (Me) if there is any question as to whether it is or not.  Granted it's easy as 98% of antibodies are significant that are identified on a daily basis.  But as I said no pathologist comments on antibody identification.

If you do anything that is not on the package insert (such as freeze the antisera) and something goes wrong, you are liable, not the company who sold it to you, as you then become the producer.
 
Also, many antisera have a small amount of albumin in them, and freezing does funny things to albumin.

My inclination is that since this is not in the package insert, this is violating the package insert and shouldn't be done prior to use for in date antisera.
 
I think you are right with that.  Is this written up in your procedures as well?  I would make a few changes.  Lab practices that are done "just because" should be looked at very closely!
 
Scott

I agree with Mabel. We do not keep enzymes so that would not have been an option for us. The only failure I see (if you can even call it that) is the ambiguous transfusion history.
I am also curious as to if the patient was symptomatic. Was this called a DHTR?

Greetings,
Does anyone send blood to inpatient units via a pneumatic tube system. If so, do you have a document that accompanies the unit that nursing fills out, verifying that the unit was inpsected upon receipt and found to be OK?
What regulatory agencies would govern such a practice? I cannot find a suitable reference in the AABB standards. Would this fall under all standards/CFR references for blood transport?
Thanks!

To take this one step further, with regards to Mabel's post, I am curious if the folks that allow 3 cells with heterozygous expression  to rule out, do you use this logic for all antibodies or just to rule out anti-K. I was never taught that it was OK to rule out using cells with heterozygous expression if you could find a cell of homozygous expression. Anti-K is frequently an example of this as is anti-E in the presence of anti-D and anti-C. The previous blood bank supervisor in our blood bank allowed rule outs using 3 cells of heterozygous expression but I prefer not to, except in the aforementioned cases.

Here is the URL:
 
http://www.fda.gov/biologicsbloodvaccines/guidancecomplianceregulatoryinformation/guidances/blood/ucm252829.htm
 
Yes, this section is talking about all things e-crossmatch.  If there is any situation where one would be required to have a second specimen for testing verification, certainly that would be in a Lab that does e-crossmatches.
 
But although the FDA strongly suggests a second specimen when doing these, it does not require it.  On the other hand, in the particular section I cited in my previous post, it does go on and on about "wrong blood in tube" errors and how a second specimen can help avoid these types of errors.
 
Scott

Do you have a transfusion committee?  If so, they might be a good one to bring this to their attention.  Also, if possible you might want to check, if you computer system is capable, and see if it is a generalized problem in ER or if you can pinpoint it to select physicians.  Another suggestion would be to get your medical director involved, it always seems to go a little smoother if you can get doctor talking to doctor.  In this day and age doing unwarranted testing should not be the norm and I imagine it will be very difficult to get some one to pay for a T&S on a diagnosis of "insecet bite".