Sophie1210

When we pool units (plasma or cryo) with both Rh pos and Rh neg the new label that prints out from our LIS system says Pooled Rh on it. When we give it out we just explain to the nurse that it means it has both Rh neg and Rh pos.

We are a level III and don't keep platelets in-house and our closest supplier is a hour away. The reason being is that we don't get many traumas and we don't transfuse many platelets. The price for platelets would be out of the lab budget and not the surgeons who wanted us to have platelets on hand. I figured out it would cost us about 18,000/yr in wasted units, so our lab director said no platelets. We do have a level II trauma center 3 miles away, so that may be why we don't get that many traumas.

Unfortunately for us our LIS was built considering anti-M to be clinically significant when identified (no matter what phase it's reacting at) so we have to give antigen negative units.

If we get question marks on the Echo and negative in tube, we'll call it negative. However, if we get a positive on the Echo that doesn't work out on the panel and negative with PEG we result a positive screen and put in a comment that it was negative in tube and no clinically significant antibodies were found. We also result an Unidentified anybody to get a hard stop so that patient can't ever get an electronic crossmatch (if at a later date the screen is negative, then our system would allow one if there were no antibody in there). We had a patient where this occurred and there was no clear cut answer on the panel and everything significant was ruled out. 2 weeks later the patient had a clear cut anti-C. Looking back the only cells that reacted were C+, just not enough and not in the correct pattern to identify. Yes, the Echo is overly sensitive but sometimes it picks things up before anything else.

We get a few equivocals (question marks) every month called by the Echo. If the Echo calls the screen negative then we call it negative. If it gives us a question mark then we take it to the bench for a tube screen using PEG.

We don't weigh our units at all. We only record volume and our computer system defaults to 350mL for RBC's and then we put in the volume found on the bag for plasma and platelets. Why do you weigh the units?

We store bone/tissue for surgery and track it. However, if there is an adverse event dealing with infection we have the Infection Control officer do all of the reporting. We have in our procedure that they will deal with anything and we can provide documentation that the bone/tissue was delivered at proper temp, stored at proper temp, etc.

Except that the Transfusion Checklist has a separate item about rare antisera. The question is - do expired panel cells fall under that checklist question? We once got cited for not having a policy defining rare antisera. So we wrote one that defined it and included expired panel cells for rule outs in that procedure. Our last CAP inspector said we were fine for that. I would think that the area specific checklist trumps the all common checklist if there's a discrepancy between checklist questions.

We've never had an order for it, but I know my local reference lab offers it as test if we needed. As far as I know that's still the definitive test.

We will allow a patent to use the same blood bank armband number and specimen for outpatient platelets/plasma as long as they stay under the same encounter number. So our outpatient cancer center gives patients a financial encounter as recurring that lasts for a month. As long as the patient doesn't receive any red cell transfusions, and hasn't in the last 3 months, and keeps their armband on we will just do one blood type at the beginning. If they receive red cells then we're at 3 days or if they get officially discharged in the system and a new encounter started we will redo the blood type.

We have in our policy that we can use expired panels for rule-outs if QC is run and is acceptable. We've never run into a problem for having this policy. There may be a cell on a panel that could help identify or rule out an antibody that isn't available on the current panel. We QC the panel by antigen typing the cell or cells we're using with anti-sera for the rule-outs we need.

We are concerned with billing because we are a small hospital and can't do DAT investigations, elutions etc. We have to send to the reference lab. If we don't have a specific order from the physician then we eat the cost of that reference lab workup. In terms of the regulatory agencies we have to work them up if they're suspected. It doesn't say that the blood bank is responsible for suspecting them or detecting them. If you have one tech (generalist) in blood bank on day shift and 1 covering heme/blood bank on evenings and nights, chasing these down ourselves is not possible. If a doctor suspects it then they can order the workup. That's what our policy states - transfusion reactions are called by the nurse or physician and not the blood bank.

We do not automatically perform a workup. We only perform a transfusion workup if ordered by the physician, because that's only way we can charge for the work we've done. We also don't have the time or the staff to chase these down and try to figure out if they're reactions or not. If the patient is stable and not showing adverse signs, except a drop in hemoglobin, then it seems more academic than anything else. Unless it would change treatment I don't see the point in doing all of that work.

Had she received any blood product? We've had 2 patients that typed Rh neg on the Echo, but had history of them being Rh pos. On the bench in tube they were 3+. Immucor claims it was because they'd both been transfused Rh negative blood in the previous month. I'm not sure I buy their explanation. I've also noticed that the Anti-D Series 5 stops reacting as well when it gets low in the bottle and sometimes comes up negative when the Series 4 is 2+.

Our computer system has an Emergency Dispense selection. We can type in the patient name and medical record number or trauma name and trauma medical record number, then we scan in the units, hit save, and tags print. We then tag the units and send them in a cooler. We usually have them in the cooler before the runner hits the blood bank for them. After everything is over, we do all the paperwork.