BldBnker

I am not sure I understand your question. 
If the mother had an admission type and screen and was rh negative, then all that would be required post-delivery is the fetal bleed screen. Why would you want to repeat and antibody screen post delivery?

I have one and if I am not mistaken, it recommends against DI water, so we use tap water and change it weekly as suggested by the manufacturer.

As someone who was the lead in the Red Cell Immunohaematology Laboratory in Tooting, London for well over a decade, I would say that it is a mixture of the two, but about 75% science.

CAP does not recognize a "30 minute" rule. Each facility has to have a validated policy and procedure that defines when a unit may be returned to inventory post-issue. That usually involves have some sort of thermometer to measure temperature upon return, especially if issued outside a validated cooler.
The time of start of transfusion is really a separate issue that was tied to the old "30 minute rule" that we all went by. The main point for nursing was that they did not pick up a unit before transfusion could be started. Pre-issue vitals, consent, orders, or any other requirement should be complete before the call for the blood. The blood should then be started immediately so that they have the maximum 4 hours to infuse it. Every minute that passes is a minute faster they have to infuse the unit. That may be a problem for someone who cannot tolerate a rapid infusion. We do not want nurses letting the unit sit on a counter somewhere for an hour while they do other things.

Have you asked the vendor who is providing the automation line for a Six Sigma or Lean evaluation of your lab? They may be able to provide recommendations for furniture and storage.

While I understand the convenience of making MTPs and emergency release a paperless process. I regard the physical signature a good reminder that issuing uncrossmatched blood must not be taken lightly. 

I second the Echo suggestion. I have had zero issues getting reagents through the whole Covid/supply chain problem period (which is ongoing). We are geographically isolated customers but still receive good support service when we need it.  Pricing for tube reagents is much cheaper when your facility is in the automation pricing tier.

We haven't been having problems with our kits, but investigations for two survey failures for false positive results a few years ago pointed to the wash step as critical. Maybe start there. What works for us is a 12 x 75 tube filled to near the top, decant well after each of the 4 washes, make sure to break up the cell button prior to adding saline, and make sure that the saline addition is well mixed (uniform color throughout the tube). We had problems when we were using NERL saline. We now use unbuffered saline with pHix added (same that runs on the Echo). I had techs that tended to fill the tube only 2/3 full with saline for the washes and who weren't making sure the saline/cells were well mixed. Changing that habit seems to have helped. 

There are no data suggesting a particular limit.  Survival is very unusual after 30-50 units of red cells, but everyone has exceptional cases like those mentioned above. We have discussed futility of care many times, and our practitioners are quite amenable and forthcoming.  We have stopped resuscitation in a young man having a liver transplant go badly, when there was no surgical path to hemostasis after about 250 units, but this is unusual too.  Bottom line, a case by case decision as to whether care is futile and/or the patient's needs endanger the well being of other patients needing transfusion.  Those are the key issues in each case to my way of thinking.

I have transfused 400u to 2 patients one night (2 traumatic aneurysms with different etiologies).  Another night a patient w an 8000cc bleed in the OR.  I had never seen folks get so much blood and survive.  All 3 walked out, though one guy was missing 2 limbs.

I have issued 148 units of products to a guy who was cycle vs car massive haemorrhage - he survived. I have issues 120ish units on an obstetric massive haemorrhage (as well as 20 6-packs on the twins) - all 3 survived. I've issued similar on AAA (with eventual bypass) - survival. I think the key is to use TEG to see whether the clotting is screwed - if they are clotting then keep going... In the grand scheme of things blood is cheap

I agree with Auntie-D.  I issued well over 100 units to the police dog handler blown up in the "Harrod's Bomb", and he also survived.

Agreed.  We don't use the ADCC, we just give M negative.  Even a little, sub-clinical hemolysis probably isn't good for patients :).

VERY good point.  When I was working at Westminster Hospital (many, many moons ago now), we came across a male Jehovah's Witness patient who swore blind that he had never been transfused, with one of the strongest polyclonal human-derived Fya antibodies I have ever seen.

Probably the primary stimulation was not the fetus, but previous pregnancy, transfusion, tattooing, needle sharing, non-sterile tattooing, etc.  Pregnancy is a situation in which B cells are upregulated (type 2 immunity) and T cells down regulated (roughly speaking) and pregnancy may have increased B cell activity to the point where previously undetectable antibodies are now detectable.  Just a theory ;).

Malcolm, I'm glad to see you are on the case.  When I first read the question in the Transfusion section I knew I wasn't going to touch it!!  Looking forward to see what you come up with.    

We used expired units for our cooler validations.

My Helmer Quick Thaw manual says you can use tap, distilled or deionized water and gives the advantages and disadvantages for each.  We have used deionized water for years.  The disadvantage in the manual states that it can cause pitting but we haven't had that problem.  We drain weekly and add CleanBath.

I would upgrade both of my blood storage refrigerators to the Helmer i-series and set them up for downloading temps so less paper trail. I would bring in a new Echo (ours is upgraded, but old). I would remodel Blood Bank (knock out a wall) to give us a little more room and a more ergonomically friendly space to work, maybe add another spot to flex to workspace for MTP events and for our students. Actually, I want a whole new Blood Bank with more room and windows! I don't want much really............

Does acquiring more good blood banking staff count?

John C. Staley, in my 30+ years also, we have never QC'd panels and have never been cited )we are AABB, CAP and FDA inspected).

When I worked in a hospital, we notified the patient directly on all lookbacks, and we also sent the patients PCP a courtesy letter.  We found that the PCP rarely notified the patient, so we chose to make our lives easier and notify the patient ourselves.

Here the Medical Director or designee is the one responsible for contacting the patient's physician. If the patient's physician refuses to contact the patient, our Medical Director or designee will end up having to do it. 

If @Malcolm Needs doesn't know...nobody knows. Lol!

I never considered keeping the opened segment used for the crossmatch.  While I can understand the idea behind it I personally consider it over the top in our blood bank paranoia.  Each segment in the line can be positively linked to the unit transfused and that should be all you need.