Cathy

We test all Rh negative mothers. We had a few physicians routinely order testing on all O mothers, but it seems we are doing less lately. Interesting thought about the spun vs unspun sample. What about doing parallel testing? All of our L+D patients have a CBC and BB hold sample drawn on admission. We add on the T+S if needed. I'm curious why your techs are having such a hard time with the proposed changes? It sounds like a good idea to me, I think I'll bring it up!

We also use the "R" number. It makes me feel more comfortable. We always used a different band for outpatients and ED. We used the medical record number for inpatient transfusions. When we asked for the medical record number to issue products, they weren't sure if it was the big number or the little number, or the top or the bottom number (on the registration card or on the chart). We also have a fair number of medical record number updates because we have so many people performing registrations. So when a patient is banded and the T+S drawn, we have the floor send down the card with the rest of the sticky labels. (We just check them and throw the card away.) Although we cannot guarantee that it doesn't end up on the chart somewhere, it makes it a little harder for them.

Hi, We are in the process of dropping weak D testing. I have another question related to this subject. Would you change the historical type of a patient who previously typed weak D positive to Rh negative now? Or would you continue testing the weak D on this patient to keep the type the same? We will also continue to test babies and autologous donors for weak D. We have not yet considered the scenario of the alleged father and possibility of liability, thanks for bringing that up!

Back to your question about the patient plasma reacting to something within the gel system. We believe we have had two patients recently reacting to something (antibiotic, preservative?) in the 0.8% suspended cells. Both scenarios were identical. Positive antibody screen, (all three cells); gel panel all positive except for the autocontrol. We diluted 3% screening and panel cells with the MTS diluent, all were negative. Gel crossmatches were all fine as well. If we suspect a warm auto we go to LISS. If we can rule the clinically significant antibodies, we use crossmatch compatible units.

I think this is a difficult topic, since we all come from hospitals of various sizes and inventories. I think communication with the physician in this situation is the most important. I would do all I could to not switch her, but would not go down to zero Onegs because you never know who is coming through the doors next. We are 2 hours away from other hospitals that might be able to help, and 4 from our supplier.

We occasionally see rouleaux. We do a saline replacement and let it go if negative.

We also perform two types on the same sample, different techs. We do this for all patients without a type in history.

Once we are at the point of using expired panel cells, it is usually only for additional rule outs. So we just run the current patient against a cell positive for the antibody we are identifying.

We also require a sample from the current admission for ffp transfusion. For platelets, we do a type initially, but do not require a new sample for further platelet transfusions.

Same here!

We use 24 hours.

The patient's arms had been draped, so I guess she had to get down to get to her arm to see the number. That is what was described to me when I asked how the two nurses could sign their names that they had identified the patient. Thank you all.

John, Do you have such a policy in place? Ideas that I have heard so far include using 2 alternate forms of id, like name and med rec or dob. I still have trouble accepting this, obviously the nurses would resort to it in other cases (when they can easily read it off the chart) and how are we to know whether or not it is an actual life and death situation. I knew right after the incident that this could be used as a learning experience and the procedure would need updating. The delay is agreeing on what to update it to. Thanks!

Hello, I would like to ask what you would have done in a situation that I was involved in. We had a 1-2 week post op cardiac patient who had been unstable since her surgery. We were issuing IgG-crossmatch compatible red cells for a non-specific antibody without any problems. On the day in question, as a last ditch life saving measure, her chest was opened in her room to try to control bleeding. A nurse called down for blood but could not provide the patient's blood bank id number. I knew what was happening so rather than insist or argue, I said fine but it will have to be considered uncrossmatched, inform the doctor. I pulled a crossmatched (O pos) unit off the shelf and wrote in black permanent marker "uncrossmatched" on the tag and placed an uncrossed sticker on the transfusion record, where the doctor would later sign and indicate the reason for giving uncrossed. This created issues. The doctor felt (initially) that this contributed to her demise. Our medical director said I should not have said it was uncrossmatched because it had in fact, been crossmatched. The doctor later understood it was compatible but still insisted that we note in the chart that the blood was crossmatched. (I was later informed that the nurse crawled under the bed to verify the patient's bb id number. ) So my question is, what would you have done in this situation. Do you have policies in place for these sorts of exceptions? Use alternate form of patient id? This patient was an O, so I had no problem giving out O uncrossed. What if she was an A with an antibody? I still say no id, no crossmatch. This happened a couple of months ago but is still nagging at me. Thanks in advance for your input.

In the past, we have gotten approval from our Medical Director and the patient's physician, to extend the Type and Screen for up to two weeks. Each patient would have to be handled on a case by case basis.

We do not QC them. All we do is keep track of the lot numbers, when received, and date put into use.

We also report out "anti-D, probably due to RhIG injection given on (date)". We also report it as a comment instead of giving the patient an anti-D in history.

Hi John, No they cannot apply for a supervisory position. Our job descriptions require a BS for supervisors. One other note, we also have a similiar career ladder for MTs. It seems to work well for us.

We have a mixture of MTs and MLTs. While an MT (or equivalent) signs out the daily work, techs check each others panels before putting into the supervisor review folder, and it doesn't matter in this case if the check-er is an MT or MLT. The same is true for our double check prior to issuing blood products. The majority of our training is done by an MLT (new techs and MLT students).

A couple of years ago, my manager designed a career ladder for MLTs. After 5 years of employment and meeting some qualifications (demonstrating leadership, thorough problem solving ability, performing tasks over and above the job description), an MLT may apply for advancement. The new job description and pay are identical to those of an MT.