jojo808

Just wondering why most use a 2nd sample only within 24 hours of collection. Does anyone see anything wrong with testing an older sample, say 3-4 days old??

Does anyone audit the units transfused in the OR? How does the individual units transfused in the OR go into the patients record? Does the units go on a flow-sheet and someone transcribes this into the chart? Does the whole flow-sheet get scanned somewhere in the chart? I'm just trying to get as much information prior to a meeting about this. It seems like most are using coolers in the OR which seems 'more safe' than one refrigerator to 'share'. I'm willing to trust the process once it leaves the blood bank as long as that is compliant with AABB and CAP.

I do almost exactly like AmcCord except I do not discard thermometers every year (but it's sounding really nice right now). I also have a spreadsheet with the serial numbers listed and the location (refrigerator/ freezer/ room temp .....) there is a column on the spreadsheet to answer if the calibration was acceptable or not. If the answer is no (>1C from the NIST) then a comment of "discarded" is added to that row. Our old SOP had instructions for correction factors that meant if the thermometer is 0.5 C higher (warmer) than the certified, a label must be affixed to the thermometer that lists the correction factor (- 0.5 C correction factor) which means you minus 0.5 C from that thermometer reading. I wouldn't waste my time with correction factors, all techs will not remember to use it, just discard it and purchase new ones, less headache for you.

Thank you everyone for your responses. As wrong as it sounds, it gives me some peace knowing that there are others going through or have gone through the same battles. And like John stated there are others 'stepping in' and just complicating the situation for blood bank with solutions that make matters worse, not better. I really appreciate the pep talk and I will pick my battles carefully and continue to do the best that we possibly can for the sake of our patients that we serve. I feel better now

I have read several threads, some maybe 10 years ago regarding this matter but I didn't see anyone really addressing the following. My question is does anyone work at a hospital where anesthesia scans in the blood unit prior to transfusion?? According to AABB 5.28.4 "The transfusionist and one other individual (or an electronic identification system) shall, in the presence of the recipient, positively identify the recipient and match the blood component to the recipient through the use of 2 independent identifiers". There is also a similar statement from CAP TRM.41300. We had a near miss several years ago, same situation, different place. One refrigerator being shared in the OR, 2 big cases going on, you get the scenario. To me, it doesn't matter how great the cooler, refrigerator, blood tracking .... there is no fool proof system but can we get close to one? one of the threads addressed the Joint Commissions Sentinel Event Alert regarding blood for multiple OR patients in the same refrigerator among other things (1999). This was 20 years ago!!!! Have we not improved this in 20 years???? Is it that hard to scan in a blood unit? Does it not take more than 5 seconds to do this??? The people making these computer decisions at our facility just can't see how important this is. Geez and in this day and age of computers all I get is "Our computer system cannot currently check this and that and blah blah blah is all I hear. Calgon take me away! Sorry for the rant but I needed to get that off my chest.

I totally agree with David. I would say most of our Anti-M's react only with the cells that have the homozygous expression and not with the heterozygous expression. I would say you have to call it an Anti-M especially if Gel is your primary method of testing with tube as your backup. I don't think you can call it negative just because the tube has no reactivity. We sometimes (very rarely) would have a Warm autoantibody that showed pan-agglutination in Gel but was negative with tube method at one hour incubation, no enhancement excluding the auto control which is usually still reactive. We would just add a comment about the negative results in tube method just for proper documentation but still result as a Warm autoantibody.

Let's try this again. Anyone using negative controls for their backtype reagents (A1 cell and B cells)?? If so, what are you using?

Hi all, I am trying to overhaul our policy for transfusion reactions as recommended by our last CAP inspector. We were basically culturing all reactions except urticaria and the inspector said we were wasting time and energy and I agree but I need more assurance for the definite criteria so I want to know what are your criteria for culture and gram stain for blood products that are in question. I've looked online and found some use only temperature increase while others use temp increase with or without other symptoms What my research has found is the following: Most call febrile reactions bet 38-40C, or an increase in temp bet 1-2C from the baseline (pre-transfusion). The ones that use other symptoms use tachycardia and/or hypotension. Just want a poll for several things: 1. At what temp do you call it a Febrile reaction? 2. Do you also use temp increase from the baseline? If so what is? 3. Do you use other criteria with Temp increase for culture? If so what are they? 4. If you do have one, what is your definition for tachycardia (eg =>100 bpm?) 5. Same with Hypotension, any numerical definition? I know there are threads on this but I don't want to sort through it all. Please, I would love as much input as possible. Add any advice or other pertinent information is greatly appreciated. Thank you all in advance.

We have had a couple cases like tkakin where the 'cold' shows in the tube but because the Gel is incubated at 37 it is spun to a negative screen. Not sure what a settle test is but what usually works for us is warming the patient's plasma well at 37C prior to testing with a1 cell and b cell. Sounds like a pesky cold agglutinin if warming corrects your MCHC.

Most references do not use the single symptom of increased BP to indicate a TACO reaction. They usually list a variety of symptoms in which a combination of 3 or more of the following need to be present: Increased BP, Respiratory distress (dyspnea), Acute or worsening pulmonary edema via xray, tachycardia, jugular vein distension, increased BNP (brain natriuretic peptide), response to diuretics...... It's up to your facility to decide what kind of criteria you want in your policy. In any case I would think this is important to note in the patient's file since the patient receives dialysis and would probably need to be transfused sitting upright and very slowly if this is indeed a TACO or TACO-like reaction for future transfusions.

Thank you, ALL the responses were helpful to me!

I am no expert on the subject but have recently read alot of references on it. I think there are a few things to consider. The first what kind of reaction are we talking about? Because of the short outdate of platelet units and the storage at room temp you would have to consider a septic transfusion reaction a possibility with platelets. The need to culture and gram stain the unit with those kinds of reactions will vary depending on your criteria for the reaction (also to collect blood cultures from the patient in a possible septic reaction). We do collect a post-reaction specimen just because that's standard for us for any transfusion reaction (except urticaria). It keep things simple for us all. For Plasma products: I would think just to cover your back that you would need to collect a specimen to verify ABO on patient to make sure you have given a 'compatible' product (again depending on the type of reaction you are talking about). On another note for platelets: depending on what your policy is, you may need to consider if a platelet transfusion with ABO incompatible plasma was given and if it's a major incompatibility (A donor platelet to an O recipient) or a minor incompatibility (O platelets to an A recipient) only because I have read that hemolysis may occur in situations like these, depending on the titer of the anti-A or B in the donor or recipient. Although the chances of the mentioned are rare, at least you can say you have done a repeat ABO recheck/ clerical check/ and maybe if Post DAT is positive then you can check Pre-transfusion DAT sample to cover your bases. This is a few things I have learned on this site among many others. Others may chime in if I have misspoken on this.

Ive seen posts here that do extend from 4 to 30 days. those that are extending their XM out do so with the patient signing a disclaimer that they are not pregnant and/or have not been previously transfused since the date they got tested. I don't know how electronic crossmatching comes in to play. We still do IS crossmatch and hoping to change soon. Whatever is chosen, make sure you have compete documentation as to why or why not the process is the way it is. We would love to extend our XMs but have alot of tourists many non English speaking and so canon rely on an-any info given to us. Good luck

Hi all, I am trying to overhaul our policy for transfusion reactions as recommended by our last CAP inspector. We were basically culturing all reactions except urticaria and the inspector said we were wasting time and energy and I agree but I need more assurance for the definite criteria so I want to know what are your criteria for culture and gram stain for blood products that are in question. I've looked online and found some use only temperature increase while others use temp increase with or without other symptoms What my research has found is the following: Most call febrile reactions bet 38-40C, or an increase in temp bet 1-2C from the baseline (pre-transfusion). The ones that use other symptoms use tachycardia and/or hypotension. Just want a poll for several things: 1. At what temp do you call it a Febrile reaction? 2. Do you also use temp increase from the baseline? If so what is? 3. Do you use other criteria with Temp increase for culture? If so what are they? 4. If you do have one, what is your definition for tachycardia (eg =>100 bpm?) 5. Same with Hypotension, any numerical definition? I know there are threads on this but I don't want to sort through it all. Please, I would love as much input as possible. Add any advice or other pertinent information is greatly appreciated. Thank you all in advance.

We also use the Typenex banding system and hand write full name and med rec#. From our experience pre-printed labels are asking for trouble. If you work at a busy hospital then more so. Because written on, our Phelps will add DOB 90% of the time, there is more than enough room for that. Hope you find a painless resolution.

We use Ortho gel and you could see it macroscopically and yes it was reproducable. Again thanks for the great info. I think we will continue antiglubulin crosshatching for now and possibly discontinue it later. We did not send to our ref lab on the basis of one positive panel cell.

Even if the antibody screen is subsequently negative? Our night shift tech initially did a panel because one of the screening cells on this patient looked 'suspicious' A panel (Ortho panel A) was tested and there was one cell out of that panel that was a 1+. He then did panel B, which was completely non reactive. Of course all common clinically significant alloantibodies were ruled out. Now if this patient continuous to come back with negative screens ... you know I'm trying to find a reason why we can stop doing this without being irresponsible. So Smiller how would you prove it was an artifact? And Dansket what does your lab do if screens are now negative? Again trying to find an out. Thanks everyone in advance!

With an inconclusive antibody ID where all common, clinically significant alloantibodies have been ruled out, how long does one do 'full/complete' crossmatch until it is no longer necessary?

So thinking out loud, I would think that with the naked eye reactivity would be easier to see with 'glass beads' due to better magnification? I'm guessing since I have not personally compared the two: even the few forum's that I've seen on this site are varied in opinion. Just curious Malcolm what have you worked with and if you have had experience with both do you (personally) prefer one over the other?

Thank you for the responses

Do not quote me on this but if you go way, way back- I think I read that a Dr.Yves Lapierre (France) created the Gel (column) testing somewhere around 1988 via a company called Diamed. Then, I believe Ortho Diagnostic acquired the right to sell this technology in the U.S in 1985. However Biorad acquired Diamed in 2007. Sooooooo if this is correct the technology should be very familiar if not the same. ???

We've had a very 'old' SOP regarding antigen typing that states we can use an EDTA SPECIMEN for up to 2 days. However when you look at the manufacturer's insert they range from 10 to 14 days refrigerated depending on which antisera you are using. Our preferred specimen for testing is an EDTA sample. Our antisera is 90% Ortho, the other is Biorad. I'm wondering if others are going strictly by the manufacturer's individual instructions or are you kind of using one general expiration time for all antigen type testing??

I agree with Kate. Sure it's hard to toss a sample but would YOU put your initials on a tube that you did not witness who it came from?? If there were to be an incident where the wrong pt. was drawn or a tube was labeled wrong, the phlebotomist is liable. Not to mention that the patient may receive the wrong blood type. I have no doubt that if you have worked in a lab that receives nurse collected specimens, then you have experienced mislabeled specimens and/or wrong blood in tubes. Set your policy and stick to it, report all those who do not follow it. Have meetings with the ER or L&D managers that you will no longer accept specimens that did not have 2 people witness. If you sometimes let it slide, then they will sometimes not follow the rules. It's like 'tough love' .. not easy at all .. but in time they will learn. Been there, done that where the ER and Lab worked against each other and not as a Team like it should be. It's 99.9% better now due to great managers and team work. Good luck!

All component storage units are equipped with an an alarm system that is monitored 24 hours/day, with alarm check (for both low and high settings) ...... Does this mean we need to check the low temp for freezers too????? I don't know how to achieve this

Thank you Malcolm