BANKTECH

Yes....make your Transfusion Form a single copy Form and let Nursing audit their own process! Here is my experience (and 2 cents worth....as I am currently changing my protocol).
I have worked at a number of places, and at most of them, the only Transfusion Slip that went with the unit was the one to be placed on the patient's chart. Also, most of this information is recorded in the computer by Nursing; so I think part of the non-compliance is that they feel they are duplicating their work.
In the couple of places I have worked where we got a copy back:
1. We then became responsible for auditing them for completeness; and ultimately, responsible for the degree to which they completed (or did not complete) them
2. There were always problems with Forms being incomplete....and on top of that, constant complaining from Nursing that we were "always returning Forms to them."
3. So, we had a protocol for returning them to be completed....then documenting them on an Occurrence Form....then me trying to work with Managers to get their Nurses to complete them in the first place.
While there was always some level of success, it was never a high enough percentage to make the Regulatory Agencies happy. And if we were not successful in getting Nursing to do it correctly, we (the Blood Bank) are the ones that would be held responsible by the regulatory agencies and be cited. If we do not get a Form back, there is no process to audit.
Do we "want" to know that Nursing has documented all of the required information; that the transfusion was completed within 4 hours; etc. etc.?? Of course we do; because as Blood Bankers, we want things to be accurate and regulations to be followed. But given my experiences, I think this is another area where we are being asked to babysit Nursing in an effort to get them to do their job (as spelled out in their Policy). We have our Policies to follow in the Blood Bank as far as documentation. The details of a transfusion are the responsibility of the Transfusionist...and I say let "them" make sure they are doing "their" job.
So, my current Form (which is a duplicate; and was so when I started here) is currently in the Print Shop and will come back as a single Form; to be compeleted by Nursing and to be placed on the patient's chart by Nursing.
Signed, the rebel......
Brenda Hutson

We are mostly 100% leukoreduced for general population and considered 'CMV safe'. However, for the neonates, we give leukoreduced and CMV negative.

Hi Everyone! Wondering if anyone knows of a good way to get adequate responses and corrective actions to errors. We try to be non punative in regards to errors, but the same errors occur over and over. An example would be when a hand written error occurs. I don't think it is difficult to line through the error and add date and initials. Same with write overs. There are other errors too that I encounter (not related to documentation) that seem to occur over and over. Just wondering what steps are taken at other facilities. Any input would be greatly appreciated. Thanks in advance!!

Don,
We are using the same amount (4 pools or 4 apheresis units = 20 plts). I am interested to know what your point of care instrument is used at your facility. Thanks!!

Hi Linyuan,
I'm afraid there is no easy way to explain all this without using a lot of jargon that make it difficult to understand, but I will do my best.
Although most people have heard of the ABO and the Rh Blood Group Systems, there are, in fact, 30 different Blood Group Systems. Within most of these systems, there are several antigens (mostly sugars or proteins that are expressed on the surface of the red cell). For example, within the ABO Blood Group System, there are three antigens (A, B and A1 - group O individuals have no ABO antigens), however, within the Rh Blood Group System there are well over 40 different antigens.
The Mi(a) antigen is found within the MNS Blood Group System (it was the 7th antigen found within this system, which also has over 40 different antigens).
Altogether, there have been something over 350 different human red cell antigens described, although, of course, no everyone expresses everyone of these antigens on their red cells.
If you lack a particular antigen, you can make antibodies against this particular antigen (alhtough you do not make antibodies against every antigen that you lack. Very often, although not always, you have to be stimulated to produce these antigens by either having been given blood that expresses an antigen that you lack, or by carrying a baby whose red cells express an antigen that you lack (expressed because the baby inherits a gene from the father that leads to the expression of this antigen). Sometimes, however, the body produces antibodies without any apparent stimulation (such as anti-A and/or anti-, although, in reality, there are stimulants within the environment.
Now, to try to answer your questions.
1) No, there is ABSOLUTELY nothing wrong with your blood, in terms of you producing the anti-Mia. Many millions of people throughout the world produce red cell antibodies, and they are as fit as a fiddle.
2) All antibodies are proteins. There are five basic types of these (IgA, IgD, IgE, IgG and IgM). All of these basic types produce lots of different specific antibodies - in your case, the specificity is anti-Mia.
The two types we are interested in, in the world of transfusion, are IgG (which are a sort of Y shape) and IgM (which are a sort of star shape). What we are looking at, in the laboratory, is the ability for these antibodies to cause clumping (the correct word is actually agglutination) of red cells that express the corresponding antigen. In your case, your anti-Mia will cause Mi(a+) red cells to clump, but not Mi(a-) red cells to clump.
IgM antibodies tend to cause this clumping of red cells without any help.
IgG antibodies, however, are smaller than IgM antibodies, and cannot "reach across" between two red cells to cause this clumping without a "bit of help". All antibodies, as I said are proteins, and all of these are a particular kind of protein called immunoglobulins. In the case of your anti-Mia, it would appear to be an IgG antibody (from the report), and one way that we can "help" the IgG antibodies to "reach across" two red cells to cause the clumping is to perform a particular test called an indirect antiglobulin test (I won't go into details - it is fairly comlpicated to explain, but is a very sensitive test), but for this test we use a particular reagent called anti-human globulin, and this is the AHG to which the report refers. So, if you require a blood transfusion, the laboratory would test (cross-match) the proposed units by this test, using AHG, to ensure that the blood is compatible with your antibody (i.e. your antibody would NOT cause the red blood cells to clump).
If your antibody did cause the red cells to clump, and you were transfused these red cells (don't worry - this blood would NOT be given to you - that is the point of the test), then your antibody could destroy these transfused red cells, and you could become very ill indeed (I STRESS AGAIN, the point of testing the blood to be transfused to you is so that this does not happen).
Haemolytic disease of the newborn happens when you have an IgG antibody of some specificity (in your case anti-Mia) and the foetus's red cells express the corresponding antigen (in your case Mia). The antibody can cross the placenta (IgM antibodies do not) and can destroy the foetuses red cells (haemolyse them). This used to be a real problem, but nowadays, as long as the pregnancy is well-monitored and, if considered necessary for the baby's health and wellbeing, there are such interventions as early delivery or intrauterine transfusions, then the baby will be born with no problems. I must stress, however, that many women have produced red cell antibodies, of many different specificities, and have had babies that are totally unaffected, despite the fact that they express the corresponding red cell antigen on their red cells - so don't worry!
I hope this explanation helps to some degree, but, if not, say so and I, or one of the many really nice people on this site, will try to explain it in a different way.