JoyG

Does anyone report the strength of reactivity of the DAT to the Hospital Information System? There are some doctors questioning this here but I was always taught that any positive reactivity would clear the cells no matter what strength. Thoughts?

Just a quick question. We have a Jkb which is not reacting with the plasma from the purple top but it is reacting with the serum in the red top which I would expect due to complement in the red top and not the purple but would it still react with Anti-IgG? We did not use polyspecific. Patient had a previous antibody, we ran out of plasma and went to the red top tube and low and behold the Anti-Jkb pops up reacting with IgG antisera.

We reported this phenomena to Ortho on 9/24/13. They asked us to perform a DAT_IgG on this cell and it was positive! We removed the cell (actually the panel) from use.

The independent double check has been something that came out in an article many years ago as a best practice for nursing (I can't remember if was an actual standard for nursing). I know in one of my previous jobs, because nursing was required to do this independent check for medications, etc, the facitility wanted to be consistent, we required to make it a requirement at issue and administration. See attached procedure for the independent check required of nursing during administration... Independent Double Check for the Administration of Blood and Blood Components An Independent Double Check as described below shall occur in the presence of the recipient prior to the initiation of all blood or blood components. The independent double check shall be concurrently documented as specified below. Participants: Transfusionist (A physician, CRNA or RN who has satisfactorily completed training and competency evaluation for the PREPARATION FOR AND ADMINISTRATION OF BLOOD AND BLOOD COMPONENTS MA05904 (IIIGen-6) Rechecker (A physician, RN , or CRNA who has satisfactorily completed training and competency evaluation for the PREPARATION FOR AND ADMINISTRATION OF BLOOD AND BLOOD COMPONENTS MA05904 (IIIGen-6) Procedure: Note: In the event of a checklist discrepancy or lack of agreement with patient consent, immediately return blood or blood component to the Transfusion Service pending resolution. Transfusionist- Read aloud item #1 of the Transfusionist Checklist (□We have reviewed the patient’s signed consent and found this transfusion to be in agreement with any stated limitations.) Transfusionist- independently review the consent for completeness, that the consent is properly dated, witnessed and any stated limitations are in agreement with the order and blood component in hand. Rechecker- independently review the consent for completeness, that the consent is properly dated, witnessed and any stated limitations are in agreement with the order and blood component in hand. Transfusionist- Place a checkmark(Ö) at item #1 indicating that you and the rechecker have verified this transfusion to be in agreement with the patient’s consent Transfusionist- Read aloud item #2 of the Transfusionist Checklist (□Recipient’s name and identification numbers on the Transfusion Record and identification bracelet agree.) 6. Transfusionist- read aloud the patient’s name and medical record number as it appears on the Blood Component Transfusion Record letter by letter stating each letter, D” “O” “E”, “J” “O” “H” “N”, and number by number “1” “one”, “2” “two”,“3” “three”, “4” “four”, “5” “five”,“6” “six”. Rechecker- concurrently with Step 6 verify the patient’s name and medical record number on the patient’s bracelet are in exact agreement with that stated by the Transfusionist Rechecker- read aloud the patient’s name and medical record number as it appears on the patient’s bracelet letter by letter stating each letter, D” “O” “E”, “J” “O” “H” “N”, and number by number “1” “one”, “2” “two”, “3” “three”, “4” “four”, “5” “five”, “6” “six”. Transfusionist- concurrently with Step 8 verify the patient’s name and medical record number on the Blood Component Transfusion Record are in exact agreement with that stated by the Rechecker. Transfusionist- Place a checkmark(Ö) at item #2 indicating that you and the rechecker have verified that the patient’s name and medical record number on the bracelet and Blood Component Transfusion Record are in exact agreement. Transfusionist- read aloud Item #3 of the transfusionist checklist (□The recipient’s ABO and Rh type on the Transfusion Record are in exact agreement and those on the unit OR Transfusion Service has initialed the statement: “ABO/Rh discrepancy noted – safe to transfuse to intended recipient”.) Transfusionist- read aloud the ABO and Rh type as written on the actual blood component. Rechecker- concurrently with Step 11 verify the recipient’s ABO and Rh type on the Blood Component Transfusion Record are in exact agreement with stated by the Transfusionist. Note: Agreement is not required if the checklist statement “ABO/Rh discrepancy noted – safe to transfuse to intended recipient” is initialed by Transfusion Service staff.. Rechecker- read aloud the recipient’s ABO and Rh type as written on the Blood Component Transfusion Record. Transfusionist-concurrently with Step 14 verify the ABO and Rh type on the actual blood component are in exact agreement with stated by the Rechecker. Transfusionist- Place a checkmark(Ö) at item #3 indicating that you and the rechecker have verified the ABO/Rh on the actual component label is in exact agreement with the recipient’s as stated on the Blood Component Transfusion Record OR the checklist statement “ABO/Rh discrepancy noted – safe to transfuse to intended recipient” is initialed by Transfusion Service staff. Transfusionist- read aloud Item #4 of the Transfusionist Checklist (□The unit number, ABO, Rh type, and expiration date on the Transfusion Record and unit label agree). Transfusionist- read aloud the component ABO/Rh type, unit number letter by letter and number by number and expiration date as they appears on the actual blood component Rechecker- concurrently with Step 18 verify the component ABO/Rh, unit number and expiration date on the Blood Component Transfusion Record are in exact agreement with those stated by the Transfusionist. Rechecker- read aloud the component ABO/Rh type, unit number letter by letter and number by number and expiration date as they appear on Blood Component Transfusion Record. Transfusionist- Concurrently with Step 20 verify the component ABO/Rh, unit number and expiration date on the actual component label are in exact agreement with those stated by the Rechecker. Transfusionist- Place a checkmark(Ö) at item #4 indicating that you and the rechecker have verified the component ABO/Rh, unit number and expiration date on the actual component label are in exact agreement with the Blood Component Transfusion Record. Transfusionist and Rechecker-legibly sign your names, title and date in the space provided on the Blood Component Transfusion Record, documenting that the above independent double check has been satisfactorily completed according to the steps above ( See Sample of Completed Blood Component Transfusion Record on Attachment F).

I agree with everyone. We would not accept it back, just infuse within 4 hours or physicians orders.

#2

Transfusion during a procedure using a procedural consent is 48 hours. Regular Blood Consent is per admission.

Thank you everyone for such a lively discussion. Much appreciated!

When you have an ABO discrepancy due to weakened (<1+) or absent serum/plasma reactivity that was resolved in a previous specimen, how often do you reinvestigate the discrepancy? For example, each specimen, each admission, or only if it differs from previously observed reactivity? In this particular instance, Patient currently forwards as a B but reverses as AB however in 2009 patient had similar reactions that were resolved with 15 min room temp incubation. The employee did not reinvestigate the current results by incubating the reverse because "this was a known history". What do you think?

Same as the others.

Thank you all for your comments!

All, I wanted to know your opinion concerning rule outs/ins using multiple methods. We have a patient that we identified a new anti-Kell and anti-Kpa. We had Kell negative and Kpa negative cells react negatively in Solid phase. We had enough Kell positive, Kpa negative cells react positively in solid phase to meet p-values but not enough Kell negative, Kpa positive cells. We then ran Kell negative, Kpa positive cells in PEG and met our p-values. My question to you is-do you then also confirm negative reactivity again in PEG by running another Kell negative, Kpa negative cell in PEG even though this was done (x3+) in solid phase? My staff want to do this to rule out method dependent antibody (ie PEG)? I hope this makes sense! When you use another method to rule in/out antibodies do you also reconfirm negative reactivity in that second method even though it was done in another? What are your thoughts?

We bill for everything. The physician's interpretation and any work that was performed i.e. repeat ABO, repeat RH, DAT (3 if positive)

Hello everyone- It is a CAP requirement TRM.40230 All blood samples used for compatibility testing are labeled at the time of specimen collection in the presence of the patient with: Patient's first and last name Uniques identification number Date of collection Identity of the phlebotomist

It is a CAP requirement TRM.40230. All blood samples used for compatibility testing are labeled at the time of specimen collection in the presence of the patient with: Patient's first and last name Unique identification number date of collection Identity of the phlebotomist

Our blood center is now going to ISBT labeling. Currently when a product is shipped that is antigen negative, the unit has a tag listing the negative antigens the unit was tested. The future process is to eliminate the tag and the antigens will be listed on the ISBT label. Our blood bank computer system does not print out antigens on the label for ISBT so our concern is: if we irradiate the product and the expiration date changes, the new expiration quadrant label will cover the antigen negative. Another concern is that the ISBT label does not clearly identify S from little s and the print is small. We are concerned that staff may miss a S from a s on small print. Has anyone else had these issues or concerns? Any suggestions?

Does anyone perform an antigen type on the patient if transfused within 3 months? i.e. if result is negative, can be reported but if result is positive, it is invalid? or do you strictly follow the 3 month rule? (not including molecular testing)

We done the same this as jmm8427. We have also renegotiated contracts.

There is a 2009 WBIT Blood Bank Safety Practices report from CAP. I have attached it here. Hope this helps. 2009-WBIT-CP.pdf

Thank you all for your responses! Much appreciated!

It's been a long time since I've performed antibody titers for HDN. In the 17th edition of the Technical Manual and John Judd's Methods states to incubate 37C for 1 hour however the CAP proficiency is for 30 minutes. What does everyone use; 1 hour or 30 minutes? Why was it changed to 30 minutes for CAP?

Did you try molecular testing your patient?

I have a question further related to this subject. For those that use historic blood types and samples from this admission which can be many days in some instances, how do you answer AABB 5.11.4 Retention of blood samples? Where patient samples shall be stored for at least 7 days after transfusion? Do you interprete this standard for red cell containing products only or all products? If all products, how can a historical type or type on admission be compliant with that standard? Thanks for any thoughts on this subject!

Currently we use Mediware HCLL. You have to release the results from the ECHO but then verify the results in the BB computer system. Techs must look at the results before they release them from the blood bank system, they are not autoverified directly from the BBIS. We wanted to interface with the instrument so that we would not have to worry about clerical errors which I think is more dangerous.

This is true as well as the OB docs follow ACOG which, last time I looked, was an antibody screen at initial and I think possibly a 28week follow up as needed but not in conjunction with the RHIG.