Texas Lynn

I was told that there are signatures of acceptability on the document. 

We have always kept the packing slip for 10 years as part of the traceability of unit, granted the information is entered in our LIS.

For the immediate time frame, with the mother in mind, consider the baby as D+ and provide RhIG.   On the other hand, with concerns for the baby, D= is how I would treat the baby. 

So why did we read tube screens at 37C in the old days.  I vaguely remember reports of anti-E that reacted only at 37 and not at AHG.  I am wondering if that was back when the enhancement was albumin.

You have to change your refrigerator alarm settings to activate at 2.2C (or whatever you choose).  It doesn't matter that your refrigerator never gets too cold;  if you are going to store reagents (and RhIg) in a BB refrig, it has to be able to alert you when then temp is out of prescribed range.

That was my first thought. I dislike what they've done with the Transfusion Medicine checklist. The All Common items that used to be 'customized' for Blood Bank were in the Blood Bank checklist where they belong. Now it's a guessing game from an All Common list that is really focused on Chemistry - does this apply to BB? how does it apply to BB? what is this even aiming to achieve??? What used to be covered in one is now spread into 3 or 4 places. Thanks CAP!

My logic is that as the FDA categorizes blood products as a drug I don’t see why they could/would have a problem. 
You may however want to clarify who will have freezer(s) access to stock and issue the vaccine etc. 

I agree with you that it does sound daft, but I am in the position to tell you why this is the recommendation, despite it apparently being contrary to BSH Guidelines, as I was still working when the decision was made (albeit, I don't agree with it!).
The huge majority of hospital blood transfusion laboratories now use column agglutination technology (CAT) as their "first line of attack", and many of them use the CAT that uses gel in the column, rather than glass beads.  This form of CAT is particularly adept at detecting anti-M in plasma by IAT, even though the anti-M may not actually be reacting at strictly 37oC.  There are several reasons as to why this is so, but a couple of them are that "cold" reacting IgM anti-M can sensitise red cells particularly quickly (in a matter of seconds at room temperature), but can take quite a time, even at 37oC, to dissociate back off.  This means that the anti-M is often still sensitising the red cells at the end of the incubation time and, of course, centrifugation is, in itself, a potentiator of agglutination.  In addition, the gel in the column is at a slightly low pH, and many examples of anti-M "like" a slightly acid environment to sensitise the M antigen.  This all means that this particular kind of CAT is very good at detecting anti-M, but making it appear to react at 37oC, when, actually, it doesn't.
This left the RCI Laboratories with a dilemma.  Cross-matching blood by tube at strictly 37oC takes a long time, and the RCI Laboratories are not, shall we say, over staffed!  This meant that RCI Laboratories were being stretched to breaking point by having to cross-match for samples containing anti-M, as so few hospital laboratories could now perform IAT by tube technique (particularly with the need to demonstrate competence in the technique being used).  The alternative was to test many more units for the M antigen, and to provide M Negative units to the hospitals, whether they use CAT of that type or not, so that they could perform their own cross-matching, and actually end up with compatible units.  In theory, this was great, but it left the RCI Laboratories with fewer phenotyped units with which to select for, say Fy(a-b+) for a patient with anti-Fya, as the M Negative units that were also Fya Negative had been sent out to cover a cross-match in a patient who had an anti-M, who didn't actually need M Negative blood.
Having said all of that (and I KNOW I said it at length), anti-M can, rarely, cause severe haemolytic disease of the foetus and new-born (particularly in people from the Far East, even when the anti-M does NOT react overtly at 37oC), and so I have a certain amount of sympathy with giving M Negative units, even in the situation in which you find yourself with your patient, as M Positive units, albeit found to be compatible by IAT, could well stimulate the anti-M to become stronger during the pregnancy, "turn it" to an IgG production and increase its (at present, non-existent) IAT titre.
I hope that helps and that you haven't fallen asleep reading it!!!!!!!!

More likely the slips must be hung onto at least until after your blood provider gets their payment.  If there is any dispute over what you are charged and/or paying for, then you have their packing slip to refer to as a sort of "receipt".  Doesn't seem like you would need to hang onto them forever.  May be a billing department requirement.
Scott

I worry about donations if people get sick in large number and they can't donate we might  experience blood products shortage.

You can use either. For products with an expiration of less than or equal to 72 hours, you must use the exact time. For products with an expiration of more than 72 hours, you can use the number of days @2359 (Technical Manual, 16th ed, pg 219). We have been using the 120 hrs but are in the process of changing to the 5 days @2359.

It was so hard when teaching students not to reach over and flip open that lid. Remember changing broken clips on the immufuges?  Or the Dade Cell Washer that added the antiglobulin?  I think that is why manufacturers started makng green antiglobulin. 

Is this person on any multiple myeloma drugs?

We do the same.

We use Immucor for our reverse (back) type and the package insert indicates that we need to confirm the reactivity of the A1, A2, and B red blood cells, not the negative results. So, we only daily QC that they are reactive.

I have read several threads, some maybe 10 years ago regarding this matter but I didn't see anyone really addressing the following. My question is does anyone work at a hospital where anesthesia scans in the blood unit prior to transfusion?? According to AABB 5.28.4 "The transfusionist and one other individual (or an electronic identification system) shall, in the presence of the recipient, positively identify the recipient and match the blood component to the recipient through the use of 2 independent identifiers". There is also a similar statement from CAP TRM.41300. 
We had a near miss several years ago, same situation, different place. One refrigerator being shared in the OR, 2 big cases going on, you get the scenario. To me, it doesn't matter how great the cooler, refrigerator, blood tracking .... there is no fool proof system but can we get close to one? one of the threads addressed the Joint Commissions Sentinel Event Alert regarding blood for multiple OR patients in the same refrigerator among other things (1999). This was 20 years ago!!!! Have we not improved this in 20 years???? Is it that hard to scan in a blood unit? Does it not take more than 5 seconds to do this??? The people making these computer decisions at  our facility just can't see how important this is. Geez and in this day and age of computers all I get is "Our computer system cannot currently check this and that and blah blah blah is all I hear. Calgon take me away! Sorry for the rant but I needed to get that off my chest. 

Is this person on any multiple myeloma drugs?

Ok, first, DAT was negative. I did the NaOh test, we only had 0.1 N. I ran a cord and adult for comparison.The cord in question did look more like an adult sample then a cord sample. Mother is O neg, so maybe it was her blood?
 It seems to me, a long time ago, in a lab far away, we would heelstick the babies if we got Rh negative and the mom was Rh negative. To make sure the baby's type was correct and if mom needed RhIg or not.

We do this test on all Rh (weak D) negative cord blood specimens from babies with Rh negative moms -- just to make sure that it is baby blood and that mom doesn't need RhIG.

If you put a drop of blood on something like a filter paper, and then add a drop of 1M NaOH, if it is adult blood, after a couple of minutes it will turn a sort of yellow/brown colour, as the Hb is denatured by the alkaline, whereas, if it is blood derived from the baby (including cord blood), the red cells will stay red, as HbF is not denatured by the alkaline for much longer.
It is rather like doing a Kleihauer, but by "bucket chemistry", as it is known!  

Could be maternal blood.  Have tried testing the red cells with NaOH?

I have seen this so many times and have always come to the conclusion that it was a mislabeled sample.  Let us know what you find.  

We once had a mismatch due to a correctly labeled but Incorrectly drawn cord blood? To be honest I did not understand the explanation on how it was, or could be drawn incorrectly?!

Yes, but the card is European.  I have no idea if it is available in the USA.

Hello Eva,
The thawed codes for E1624 are listed below. I have included the codes for products with a 24 hour expiration and 5 day expiration, in case you need both. You can use the ISBT 128 Product Lookup Web Application to look up the full descriptions.
24 hour expiration: E2284 5 day expiration: E2121 The division codes (A0, B0, C0, etc.) would also use the same 5-character thawed Product Description Codes. I also wanted to clarify that the second character of the division code is a “0” (zero), and not the uppercase letter “O”. Section 5 in the Implementation Guide: Use of Product Code [Data Structure 003] - Blood (IG-021) document further discusses division codes. (Please note, you will need to be logged in to view the document).
I hope this helps, Eva! Please let me know if you would like some more help with finding additional codes.
Kind Regards,
Kaytee from ICCBBA (Organization that maintains and develops the ISBT 128 Coding and Labeling Information Standard)