Maureen

We are using Echos and prior to that we had a Galileo. There's an interesting phenomenon that can occur with automated solid phase that can cause a positive screen and then a negative panel. I have personally seen it happen at least twice. If there are bubbles/foam on the top of the specimen the instrument will pipet the bubbles/foam and this underpipetting of specimen can actually cause the absc to be look positive. When the panel is performed, the bubbles have already been removed and the instrument pipets the plasma correctly, the panel is negative. All of our techs are taught during training to inspect the specimen for bubbles/foam prior to placing on the instrument but sometimes it is a step that is overlooked when it's busy.
Another cause of false positive can be using cold undermixed indicator cells. If a new bottle of indicator cells is placed on the instrument without allowing them to warm the cells may not resuspend completely prior to being pipetted. Since the instrument pipets from just below the surface of the reagent it's possible to not have the proper amount of cells. This also occurs when bottles are loaded without a stirball having been added to the bottle.
Just a couple of other ideas for troubleshooting.

The other hospitals in our system do not require a current specimen. We don't do it at our hospital. I worry since I have seen it too often someone using a relative's Health Insurance Card and having a complete different type. We don't need a specimen though form 3 days. If they have had a specimen during the stay, we will thaw plasma.

I will try here or message me your email and i will send it that way.
https://pstat-live-media.s3.amazonaws.com/pdf_cache/policy/5813043/b3d2aae0-704c-4ada-9bd2-dad644dffb48/TS-045 Lookback-Recall- Withdrawal Notifications of Transfusion to Recipients.pdf
this will only last for 30 days
Been a while since we updated this too, but it has gotten us through these lookbacks/withdrawals for a long time.

I concur with the second theory. And is any else besides me annoyed when physicians order "lyme titers", "giardia titers", "hepatitis titers" etc on any number of qualitative tests that we do? Aside from prenatal antibodies and ANAs, there aren't too many other things these days we actually titer. So I think that not many doctors know what a titer actually is, let alone interpret one.
I caught my daughter, a budding pediatrician, misusing the titer word, and corrected her. I asked her if she wanted to be just another dumba*s doctor who was the laughingstock of the laboratory. She have me a crude response. That ChristmasI gave her Blood Transfusion Therapy: A Physician's Handbook and the Circular of Information in her stocking.

Helmer has new platelet agitator and incubator coming out in September.  I would get a quote for the new one and wait if you can.  I am looking to replace mine and am downsizing to the smallest one.  I attached the spec sheets and brochure that Helmer just sent to me.  Looks like a lot of great features to the incubator!  Continual temp monitoring so no need for every 4 hour temps!
Helmer Pro-Line Platelet Brochure 380450-1.pdf Helmer TDS-PC100-Pro Platelet Incubator Spec sheet.pdf Helmer TDS-PF15-Pro Platelet Agitator Spec sheet.pdf

Due to the lack of definitive guidance via actual studies (Seriously, how can that be done?), we have taken a 'logic' approach with our policy (my comments for this posting in italics) :
Select Product in this order ...
Indated product using shortest outdate first.  (This means that plasma that is already thawed is used first, regardless of ABO Group as long as it is not Group O, see next rule.)
ABO Group: ABO compatible are preferred but not essential.  (And then there's a chart because it is a procedure and that has to have everything in it.)
Do not issue Group O to a Non-Group O or Group Unknown patient without the consent of a pathologist. Caution: The use of ABO Incompatible plasma may cause significant hemolysis if sufficient volume is given (e.g. over 1000ml) within a 24 hour period.  Notify attending physician prior to ordering and/or issuing so an assessment could be made of the risk vs need when larger volumes are anticipated.  (And then instructions about how this is done and documented.)  
 
 
 

We implemented the "extended crossmatch"  several years ago after we had a very angry physician with a scalpel in his hand and a patient on the table with multiple antibodies that we found just before he started cutting. The patient had been prescreened for everything but BB about a week before. By the time we got our specimen and had completed the T/S, the patient was draped in surgery. Surprise! This process has made our mornings much easier and we get very few bad surprises now. We only do this process for pretest surgery patients and only if they have not been pregnant or transfused in 3 months.
 
It took a lot of education and some missteps to get the nurses and physicians to understand there was a process that had to be followed exactly. This is a process with lots of steps that has evolved over a long period and we seem to have it pretty much perfected now. Everyone knows what needs to be done but it wasn't easy to get to this point.
 
1. We have a form that is used at pretest if the physician wants a crossmatch or T/S for surgery. The nurse will ask the patient about pregnancy and recent transfusions. The nurse must sign the form indicating that they asked the patient the specific questions and send the form with the pretest specimen.
2. We do a T/S and historical check. We put a comment in the computer that the patient has an extended crossmatch. We put a colored round sticker on the top of the specimen as a sign that the sample should be held for longer than all the other regular specimens.
3. Two days before the expected surgery we fax the same form to surgery holding so the form can be placed on the patient's chart. The holding nurses know to look for the form when the patient arrives. If we need a second specimen for ABO recheck, we have a place to indicate that we need a new sample.
4. The morning of surgery, the holding nurse will ask the patient the same questions and sign the form in a different spot and collect any specimens we indicated we needed. They fax the form back to us with the second signature. We have the answers to the questions and any specimens we need before the patient goes back to surgery. We remove the comment from the computer and order a specific computer test for the extended XM if everything is signed and looks OK. We locate the pretest sample and remove the sticker from the top. The crossmatch now has a 3 day limit.
4. If the patient is found to have antibodies at pretest, we know prior to the morning of surgery. We indicate on the form that is sent early to holding that a new sample is needed. We have time prior to surgery to screen or order antigen negative units and are able to crossmatch them with the new sample without much stress.
5. If there are any problems or concerns, we want a new specimen collected the morning of surgery and we start over with a new T/S. If the patient name or identification has changed, we can't find the pretest sample, the nurse didn't sign the pretest form and we didn't notice, etc.  
6. We tried to go with different lengths of extending (10 days, 14 days, etc) but finally settled on one month. Some patients would cancel surgery and come back after the extended date. It is easier for the techs to look at the pretest day and make a quick decision on the fly if we need a new sample. If it is close to one month we just tell holding we need a new sample but we already know the patient is negative for antibodies. Holding knows to call us if the patient had surgery cancelled so we can let them know if the sample was discarded or if it is close to or past a month. Most surgery is done within a week or maybe two of having the pretesting performed. Very few stretch it out to close to a month
 
If any of the steps are not followed as we require, the patient can't be extended. They have to follow our rules for all of us to be happy. The physicians are happy because they don't have to make a decision to continue surgery without crossmatched compatible blood.
 
We have found the occasional autoimmune problem prior to surgery using this process and we can easily discuss with the physician at his office and have all the medical release forms waiting in holding.  It is easier than trying to explain autoimmune to a physician with a scalpel in his hand.  

Whether you call yourselves Lean (or Six Sigma or some other facetious productivity name) or not, the reality for many labs these days is that generalists are more and more necessary to keep things going in light of personnel shortages,
We are a 250 bed level 2 trauma hospital, with a fair amount of Lab work on the type of patient population we see, including BB.  The only real "dedicated"  techs we have are in Micro (and of course, Histology). About a quarter of the techs on first shift are generalists that can work on a regular basis in BB (in addition to the main Lab area).  On second and third shift, virtually all of the techs work BB in addition to the main lab area.
Whether one has BB with all dedicated staff or no, the key is to have adequate training and competency, along with extensive references, including having good P&Ps available.  This is true for all areas of the Lab (and in health care in general!).  It requires a sharp and dedicated management model and staff.
Scott
 

I contacted the company and received written guidelines describing storage limits. It was acceptable. 

I interpret "Transfusion Requirement" to mean the PATIENT's requirement, i.e. "this PATIENT requires Irradiated products".  Irradiation is a unit ATTRIBUTE.  So you would need to print that patient requirement on the compatibility Tag/Label along with the other required patient information.  Our tag (Cerner) would include both unit attributes and patient requirements.

I would say that since they mention "a label or tag", that they are thinking that a label would be something that is stuck to the unit, and between the labeled unit and the transfusion tag all that required info would be there.
Scott

If I remember correctly we did not require an antibody screen if we had a record of a negative result during the current pregnancy. Otherwise one was performed.  At least that's what I seem to remember.  

We added a note in our labeling policy what the truncated name would look like, ie a name more than 35 characters would be truncated at 35 characters and have a plus sign. We compare as much of the truncated name as possible, the unique BB identifier number, and another identifier like mrn or DOB.

I've attached my QP for errors/accident reporting.  The FDA stuff is towards the end.
Errors 1.2.doc

We switched f/ an in-house created/validated Igloo system to MaxQ.  We love them!  They are plastic, so we can decontaminate after each use.  When we did our validation, we maintained temp for > 24 hours in rooms @ 22, 65 (heart room), & 85 (trauma room) degrees.  The lid is hinged, so it swings closed if someone forgets.  We use a saline bag connected to a digital thermometer that sits in a pouch on the lid.  This allows someone to constantly see the internal temp.  We issue up to 6 PRBC/cooler, but it would probably hold more.  I do think that they mentioned an upcoming upgrade w/ remote temp monitoring, so you might wait for that... I attached a Word doc that we used for PCS education.  It shows pics of how the units are packed.

New Blood Coolers.docx

The thing is tkakin, that most examples of anti-C (anti-Rh2) are not; they are actually anti-Ce (anti-Rh7)!  This is largely because almost every red cell that causes immunisation against the C antigen expresses both the C and e antigens as a result of having the RHCe gene, rather than both the C and e antigens as a result of having both the RHCE gene and the RHce gene (which is why both the DCE and dCE haplotypes are so rare).  On the other hand, monospecific anti-e is comparatively common.
So, your lady's plasma is more likely to contain anti-Ce and anti-e, rather than anti-C and anti-e.  As a result, if, as yan xia suggests, you would undoubtedly adsorb out the anti-e, but you still would not know if the remaining antibody specificity is anti-C or anti-Ce (or, of course, a combination of the two).
Anyway, the specificity really doesn't matter.  The point is that, as you suggest, the individual titres of what ever antibodies are present are totally irrelevant.  Normally, an antibody, such as anti-C (or anti-Ce) or anti-e, are not going to cause clinically significant haemolytic disease of the foetus and newborn, until the titre reaches 32, and it really doesn't matter whether the specificity of the antibody is anti-C, anti-Ce or anti-e.  Your Pathologist should explain this to your OB doctor to get him or her off your back (actually, to be honest, your OB doctor should already know this, but hey, life ain't always like that!).

I don't need them anymore but they are still fun!!  

THANKS FOR THE CHRISTMAS PRESENT!  FRUSTRATION RELIEVER!

We also allow phone orders for emergency release and get the paper signed afterwards.  The only time we insist on a signature before issuing is if we know there is a problem with the patient, known antibody and no screened units, etc.  We feel this is important enough to have the paper already signed so the doc can't say, Oh we didn't know there was a problem...  That form is called the High Risk Transfusion form.

Similar to David, above.  Also, when an order is put in on our hospital system, for uncrossed products, the doc is also documenting authorization.
Scott

the doc is going to sign for emergency release.  If it seems to be abused the Medical Director will become involved.
HIstorically I accept phone calls for emergency release, get the blood out and the paperwork is completed after the excitement dies down.  Never had an MD refuse to sign after-the-fact.

The AABB annual meeting, and I also attend the BBANYS (Blood Bank Association of New York State) annual meeting. Wish I could afford to go the SABM annual meeting.

AABB is probably the most important in the US - it is held in a different region every year.  Each state or small region usually has an annual blood bank or laboratory conference every year.  I tend to go to the Portland, Me for the annual CLMA conference - usually lasts 4 days, all kinds of lab topics and vendors.  It is regional for Northern New England but pulls from outside this region also.

In England, there is the annual BBTS Conference, the two-yearly IBMS Conference and the annual University of Westminster Transfusion Update Symposium. There is also a quarterly meeting of the London and South-east Transfusion Science Technical Advisory Group.
In Scotland, there is the annual Scotblood Conference.
Of course, there are the European ISBT Meetings.

AIMS sponsored by SCABB in the spring.  Great meeting!