slsmith

We have EPIC and the electronically signature of physician ordering is included in the "emergency uncrossmatched red cell " order that is placed by the RN. I imagine it works the same way as sgoertzen says but it is the RN or Resident putting in the order, not the lab

Yes as long as there is enough plasma for performing the screen and back type(we still use tube for the ABO). If there ends up being an antibody the patient is redrawn. And I never thought of looking for expiration dates as I been relying on the lab assistants her check the expiration dates on their supply and Material Services to check the expiration dates on the nursing units.

We use it when working with a patient with a warm antibody that has had all significant antibodies ruled out by the reference lab. The gel screen is still performed each time to make sure reactions are not getting stronger or no longer demonstrating. Then the saline panel is performed. We also transfuse with phenotypical matched blood for Kell, C, E and c . This procedure is usually being performed on the frequent fliers that we know are only coming to our hospital. We also use it when a gel shows no pattern, all cells positive or negative and we have gone to PEG and all cells are positive. The saline panel has to have at least 8 cells and ran with an auto control. If the panel is negative including the auto control it called a NSF and saline tech is use for the xm. IF the auto control is positive it is called a warm auto. If it is positive the work up is sent to the reference lab. The principle behind this I can't explain it is just what we do.

We reserve 2 segments at check in and save for 7 weeks, one week per bag. The transfusions bags are discarded on the floor

For patient's less than 4 months old we give either O= or O+ red cells that are irradiated, hbg s neg and less than 5 days old. We also split the red cell as quite often the team only use 1/2 the unit at a time. Patient's 4 months-10 years we give type specific, hbg s neg and split. The unit is fresh by that I mean it isn't expiring in the next week or so.

Our protocol is : >less than 4 months old : O neg or O pos, irradiated, less than 5 days old(working on moving up to 7), hem S neg and split. >4 months- 10 years: type specific, hem S neg and split. The split requirement was made by the cardiac team.

shipping documents/ transfers: 10 years

From the hospitals in the system since we follow the same procedures , perform the same competencies and share the same data base we accept the results. Although we do perform another ABORH (not a standard just our process). From another hospital system we will honor any antibody that is reported, just to be safe( never the ABORH). We have a test that we can order that allows us to entered it into computer without charging the patient for a test we didn't do but stops someone from issuing blood not antigen negative for that antibody.

The hematology department does the KB. There is a built in table when the KB is resulted that states how many vials of rhogam is indicated, which is doted out by pharmacy. Only BB involvement is if they did a fetal screen which turns out positive they give hematology the sample, the KB is automatically reflexed based on a positive result. Hem and BB share the PT testing. The leads work together on who is assign the samples , review the results and submit to CAP. The only "trouble" we ever got in was on what medical director signed the attestation form. The site medical director was signing it but according to CAP it should of been the BB medical director. Not an issue anymore as now it is the same person.

Know your coagulation. I was hit so heavy on those questions I was wondering if I was taking the test for the coagulation specialty.

The average amount of blood in the red cell units we receive is 350 ml, ranges from 300 to 400(seldom seen). If the order is over 270 we select the smallest unit we can find( weigh it) and give the whole thing to the nurse, instructing them to transfuse the amount desired and discard the remainder. They use a pump so can measure the amount to transfuse. And it would be a rare occasion that we would use the remainder of that bag on someone else because we really aren't a "one and done" transfusion service and would end up starting another unit which would mean another exposure so we try not to do that

We run complement cells with the daily QC, against the AHG. For patient testing if we get a positive DAT and the patient is an adult, we break it down between IgG and C3. The reason we do this is if the C3 is positive and the IgG is negative the BB is done with their testing and any follow up. If the IgG is positive and the patient has been transfused in the last 14 days we perform an eluate

As David said there isn't a BB standard for time frame a transfusion needs to be started but for some reason this time frame is in the nursing policy, theirs is 20 minutes. Where they got this information I don't know. Anyway if blood is sent to the floor and it isn't going to be started in 20 minutes and the floor asked calls the BB (before they actually return it) we tell them if they are going to transfuse and it is will be completed within the 4 hours that it was issued to the floor keep it, otherwise it will be discarded (if temp is greater than 10 degrees)

Here is our aliquoting procedure, hope it opens okay. I may be a good Banker but when it comes to computer uploads, downloads or whatever not so much. Sheri SKM_C55821040507520.pdf

BPAM

We crossmatch the A or B cells(the red cell itself) to the babies plasma, using the IgG gel card.

Our purchasing people have stated there is a nation wide shortage on plastic items, not only the mla pipette tips but mts and and transfer.

The liquid plasma we received from Bloodworks NW has a 26 day expiration date. But we change it to 14 from the collection date because our medical director wants to avoid the potential hypercoagulability (he read this somewhere?). We also irradiate the LP because all our products are leukoreduced and these are not

My scary story is the time a nurse who transfused the wrong patient because she not only didn't compare the unit to the arm band but did not read the the unit off with another nurse. It was caught because the nurse of the patient that unit was meant for called the BB asking where her blood was. The transfusion was stopped before the whole red cell could be given. Fortunately for the patient the unit was O pos (his type) and antibody screen was negative. Unfortunately for the nurse she no longer has a job.

Only thing read Microscopically is the fetal screen which is the procedure for that test. According to the literature out there (see Issett) no other tests should be read microscopically

We performed elutions when the DAT is positive in IgG and the patient has been transfused in the last 14 days. There could be a rare instance that we would do an elution anyway but I can't recall a time that we felt it was indicated.

Our facility saves for 10 years and then discards

We have to order on demand but fortunately it is usually less than 24 hours. To keep track cause it was rather a mess in the beginning of all this a copy of the order(doctor's) is kept with the copy of the order that is placed with the blood supplier on a hanging file in the BB. Our Blood supplier requires a MR# when we order which is they place on the product receipt form along with the unit number of the plasma. A message is also put in the shift report so staff know to expect a delivery. Once the shipment arrives it is brought into inventory and if the floor doesn't need it yet it is put in a designated spot in the freezer. . The availability is documented on a white board in the BB and noted in the shift report that it is available. The order is left on the dispense desk waiting for the floor to call saying they are ready. It has been working.

The doctors have a choice here to selected irradiated red cells rather than red cells and adding a comment . Also once we know a patient needs irradiation we have a "special needs" requirement we can assign to patients. If the Tech tries to dispense a product without the special need they receive a message they have to over ride in order to go on. Of course they can over ride it or not dispense but then they are in deep do do.

Only time we crossmatch ahead of dispensing to the floor is if the serologic crossmatch is required. Then we electronically crossmatch usually crossmatch/dispense when the floor calls for the product. We attach the order to a form we have(we call it the WIP) that has the patient's identifiers, ABORH/antibody screen interpretation, date of collection and special needs. We keep it in a file at our dispense area until the clot expires or patient is discharge. After that we filed it away in storage boxes that are kept for 10 years. Since we have been doing this we seldom have red cells expiring on us. Now is I could say the same for the platelets ):