csjuarez

Would it be possible to interpret the 1+ reacton as Positive, but add a comment that the weak serological reaction (or molecular typing) indicate a probable Partial D and recommending the administration of Rh immune globulin during pregnancy?

We use the Soft LIS system. Our pre-admission outpatient specimens are extended for 14 days if the patient hasn't been pregnant or transfused in the last 3 months. We are able to update the expiration date for the sample in Patient -> Orders -> Modify when we are reviewing the patient's history and receiving the specimen in the Blood Bank. The expiration is automatically set at 3 days for all patients, so the tech receiving the specimen makes the change manually.

This checklist item has been recently revised. The note indicates "Laboratories must have a policy on how to handle truncated names on labels, if applicable." We are trying to determine the best way to handle this since with computer generated labels the full name is sometimes truncated, especially when the patient has a compound last name. I'd welcome any comments as to how your facility is handling it. Thanks!

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We had our Vision update a couple of weeks ago without a problem. There's some revalidation to do but it's relatively easy and went well. The instrument was unavailable for patient testing most of the day shift between the field engineer's work and our validation process.

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We were cited on the 30 minute rule at our last CAP inspection. We now rely on the temperature of the unit, taken with an infrared thermometer, if the unit is returned. The unit must register < 10C to be acceptable back into blood bank inventory. And we see, too, that the temperature can be out of range within a relatively short period of time.

I agree wholeheartedly with this! It's not what's done at my current lab (we do an IS XM with the gel XM), but it was the way I had implemented it at a previous blood bank. We had no issues with the inspections.

Congratulations! Enjoy your retirement years. I hope you do continue to monitor and participate in this forum as your knowledge and expertise are invaluable!

I used the Grifols Wadiana AKA Provue when I worked in Saudi Arabia for a few years. Wadiana & Provue are same instrument. In SA our reagents came through Diamed, so don't have any direct experience with Grifols or Erytra customer service or products.

I don't see any need to perform an antibody screen if only plasma is being transfused. ABO compatibility is the only requirement.

I can understand such a protocol if the backtype is undetectable and a coombs crossmatch is not otherwise required. However, if you are using a computer system for crossmatching, it should already have the protocols integrated to assure ABO compatability and such a serological protocol should only be needed during downtime.

I believe there may be a CPT code for ABID testing by per cell testing. The Red Cross in our area bills like this - sometimes by cell and sometimes by panel.

I served for 2 months this summer with Mercy Ships (www.mercyships.org) on board the hospital ship Africa Mercy in Lome, Togo (W. Africa) and will be returning to the Africa Mercy in January 2011. We have a unique way of dealing with the the transfusion needs of our surgical patients -- our crew members serve as a "walking blood bank" and we do not store any processed units. Donors are drawn and the still warm whole blood unit taken to the OR suite or patient ward for transfusion! To do this we prescreen the donors which makes them available for 21 days (I'd like to change this to 30 days) and use that sample for crossmatching as well. In our case, the viral testing is done before the donor is drawn for actual transfusion, but not with FDA approved methods -- we are working in a third world country. I think it would be difficult to impossible to have a "walking donor" policy (other than as mentioned by Heather or that initiated by the Armed Forces for critical emergencies) and meet AABB/CAP/FDA requirements. I certainly wouldn't recommend it and would encourage you to plan to meet possible emergency needs by having an adequate inventory and working with your blood supplier for meeting unforseen emergency needs.

My supervisor is responsible for contacting vendors and making arrangements for purchase or donation of equipment. However, if anyone on the forum is in a position to make such an offer, you can contact me by private message and I'll put you in contact with my supervisor. Since most folks have sealers now, and probably in most cases backup sealers, I was just putting out a plug to see if anyone had some of those metal crimps and tools sitting in a drawer somewhere... if so, I'll be glad to take them off your hands!

I've just returned from a 2 month period serving with Mercy Ships (www.mercyships.org) on board the hospital ship Africa Mercy in Lome, Togo (W. Africa) and will be returning to the Africa Mercy in January 2011. We have a unique way of dealing with the the transfusion needs of our surgical patients -- our crew members serve as a "walking blood bank" and we do not store any processes units. Donors are drawn and the still warm whole blood unit taken to the OR suite or patient ward for transfusion! Many things are done differently there than here! But, one thing perhaps some of you might be able to help with is a need for a better means of sealing off the units of blood we collect for transfusion. Currently we are tying a couple of knots in the tubing before beginning the collection, then tightening those knots once the collection is completed to seal off the unit. I've asked my supervisor to see about obtaining a portable tube sealer, or at least the metal crimps, crimping tool, and tube stripper, as well as a collection scale. She will be persuing this, but in the meantime, if anyone out there has some of those metal crimps, crimping tools, or tube strippers sitting around that you no longer use, perhaps you might be able to donate them. Feel free to contact me about that, or if you might be interested in serving for a few months or a few years with Mercy Ships!

In response to the new CAP Checklist item (TRM.31450) we have begun using the sample from our CAP Transfusion Medicine-Automated (JAT) survey after we have run them on the ProVue and the results are submitted to CAP. We test those same samples in the tube for ABO/Rh and Antibody Screen and also manual gel. Since we get the survey 3x a year, we have our bases covered.

How common is the practice of routinely running both a regular and ficin-treated panel? It seems that such a practice (like routinely reading tubes at IS, which has somewhat gone out of practice) just leads to unnecessary complications and lots of time & energy chasing clinically insignificant antibodies.

We do not change a positive screen result to negative. If the screen is positive, we perform an antibody ID. If the presence of alloantibodies to common red cell antigens is ruled out, with or without additional positive cells, we report the antibody ID as inconclusive and perform coombs crossmatches. In the future if the antibody screen is negative then computer (or immediate spin) crossmatches can be performed since a clinically significant antibody was not identified. Sometimes the more testing you do, the more confusing it is! Every testing system has it's strong and weak points, but who can afford the time and expense to attempt multiple procedures? Outside of a reference lab it is often times difficult to identify such a low incidence or weak antibody, and even then crossmatch compatible units are the best you can do. I'm also one of those who vote "NO" on the use of microscope under most circumstances for antibody ID. Though gel is our primary method, LISS is occasionally used for special circumstances and I strongly discourage routinely examining these tubes under the microscope. We do use it when macroscopic resutls are questionable, as well as for DATs and FMH screens, though.

Still as clear as mud, though!

You might also consider, as far as the strength goes, that many antibodies seem to give stronger reactions in gel than in some other methods of testing.

I'm actually surprised a Reference Lab would use this rule-out protocol. When I worked in a reference lab we used three rule outs (homozygous when possible, though K and C & E in the presence of D were notable for the allowed use of heterozygous cells). My current lab requires 2 homozygous cells for rule-out (except for those situations noted above) and another lab I worked in required only one homozygous rule-out. I think that using only one cell, particularly one heterozygous cell, to rule out any clinically significant antibody is not a sound practice since it increases the likelihood of missing the antibody due to the variations in strength of reactions mentioned in other posts. Of course, that's just what we do when we accept a negative antibody screen, though, isn't it? I'd expect a higher level of performance from a Reference Lab, though.