jojo808

We have a pre-op clinic where the patient comes in about a week to a month prior to surgery and has all pre-op testing done which usually includes: CBC, Basic metabolic panel, PT, PTT, ABO/Rh type and antibody screen (no banding). Other tests that may be included are a urinalysis, and x-rays. It takes only one incident of a crossmatch drawn on the day of surgery, comes out positive, and time /$$$ wasted for our MD's to learn to order these pre-op antibody screens in advance. When the pt. comes in on the day of surgery, the type and screen gets repeated (with banding) and there are no surprises. I know it involves repeat testing but as long as the MD's code it correctly it is usually covered by insurance. We average about one positive (pre-op) antibody screen 2-4 times/year. When this happens, the pt will come in a day before surgery and get redawn, banded for surgery the next day, and the blood bank will have already identified the antibody on the pre-op testing and will have units ready for crossmatch. It's been working well ..... we used to do it on the day of surgery but like I said it took one incident of a big open heart surgery to change all that.

Wanting more answers!! Looking at the 1st scenario posted by wellspl: So let's say the transfusion of additional units is at the discretion of the MD (either lab medical director or attending). What would he/she consider before making a decision? Anti-IgA testing? What else could be considered if all the clerical and testing rechecks are correct?

I never used Cerner but had 3 travel techs over several years comment on what a great system Cerner was.

Yes pt was typed C, K neg and was given 2 units (5 years ago). Thank you all for the posts and I did end up giving e,C,K neg units but wasn't sure if I was overdoing it or not. But like Malcom Needs said I wish the C and K would have been ruled out initially!

Trying to find out what everyone else does: Patient has a history of Anti-e with being unable to rule out C and Kell 5 years ago. Presently, patient's antibody screen is negative. We would transfuse with e neg full crossmatch compatible units. Do we also need to give C and K neg units? (It was not identified 5 yrs ago, just unable to rule out). Although the e neg units would statistically be K and C neg also, I wanted to know if we HAVE to give those antigen neg units because I think we could charge for the time and cost for the testing if so. Any thoughts on this? Thanks in advance.

thank you, I stand corrected. Great information!

A late reply but we do pretty much the same as mollyredone. You either finish the workup completely (they would have to wait) or the ordering MD signs the emergency release form. There are check-off boxes on our forms. 1. ABO/RH not done. 2. Antibody screen not done. .3 Crossmatching not done. I can't remember the 4th. As bloodbankers, our job is to completely finish the workup which means giving "compatible" blood. Anything less than that is technically "not compatible" (yet). As medical doctors, they decide whether it is a life or death situation. They either sign the form or wait. Correct me if I'm wrong but I tried to look up transfusion fatalities and I didn't see anything related to antigen/antibody incompatibility except with the ABO/Rh system. I don't think it would be fatal but certainly wreak havoc in vivo if a patient were given ag/ab incompatible blood especially in an emergency situation where the underlying condition for the emergency visit (anemia/hemorrhage) makes the patient vulnerable.

Patient #2 Happened to us twice. Both were bone marrow transplants.

Not sure about the A2, the notes only stated A

Prior to transplant patient was a B+ and eventually got A+ cord blood units. Anyway pt was admitted to our hospital and forward typed as an A+, backtype was non-reactive (AB). Antibody screen was negative. We didn't know about the transplant and initially thought maybe an A subgroup but after we found out about the transplant (through progress notes, you'd think the nurses/md's would have given us that kind of info!) we gave O+ rbc's (2 irradiated/ cmv neg units). Progress notes said100% chimerism. we gave one A+ rbc unit. On the next crossmatch specimen the screen was still negative but the immediate spin crossmatch with an A+" unit had a 1+ reaction. We tried an O+ unit and it was negative so we are back with O+ units. Question: Were we wrong in giving that A+ unit? Should we always transfuse group O rbc's to bm transplant recipients?

If we get a "code 500" specimen the name will either be a Jane or John Doe. If the identity gets corrected by the time our unit tag prints out then the blood band will say Jane (or John) Doe and the tags will have the correct name. In those cases we enter a unit tag comment as "AKA Jane Doe" Our hospitals LIS system automatically updates/changes the name as it gets corrected. We try to draw a new specimen the nextday or as soon as the critical episode subsides.

Just curious on how many of you do a post-transfusion workup with a urine collection and how do you differentiate hematuria from hemoglobinuria? We do the following which I believe most of us do: 1. Clerical checks. 2. Check concentration of Saline Solution that is usually piggy backed to the donor unit. 3. Draw Post-transfusion EDTA to check for hemolysis and DAT ( if DAT is pos, we test pre-transfusion specimen). 4. ABO/RH recheck on donor units. We also do a dipstick and microscopic on a urine specimen and need to notify a pathologist if it is Positive for blood which it usually is: maybe 0-2/hpf on the microscopic and maybe trace on the dipstick. We usually don't have a pre-transfusion UA to compare with but even if we did most of us don't feel comfortable calling a pathologist at 2am with those kinds of results. I don't think we should notify a pathologist unless the supernatant of the SPUN down urine is bright red ... but that's me, what do you guys think???

Thank you all for the explanations!!! I get it now

I'm trying to follow this post but it's confusing. If the thought is to irradiate (PLTs) to prevent GVHD by inactivating the T-cells then why not irradiate the RBCs? (especially if the residual leukocytes are about the same in both components). It's leuko-reduced RBCs not leukocyte-free RBCs. Sorry if it was clear to the rest but it seems like every other post says yes you should then no not necessary. I want to learn about this because we are presently having discussions about guidelines on when to or not to irradiate and or give CMV neg blood products. Also, does refrigeration inactivate cytokines that may be released from WBC's too?

1. Yes 2. Yes 3. No, when MTP is implemented (>10 units in <24 hours, or 4-5 units/hr) we start an abbreviated or "electronic" crossmatch where we also skip an immediate spin crossmatch and give type specific units. 4. not applicable to our hospital.

From what I understand recipient notification is necessary if a donor has been repeatedly reactive or confirmed positive for HIV or HCV testing. Our policy also declares we make 3 attempts (via certified mail) to the recipient and the recipient's primary care physician of the exposure. I think there is a time of 8 or 10 weeks to accomplish this. We have a template letter to the MD and a different one for the recipient with check-off boxes of whether it was the 1st, 2nd, or 3rd attempt of notification for HIV/HCV positive testing on the donor. My questions: 1. If recipient is deceased, I read that we need to notify next of kin or legal representative. Is this true for both HIV and HCV?? 2. Does anyone notify the recipients physician for positive, confirmed testing for HBV or anything else that your supplier tests for? Just want to make sure we are doing it right.

Thank you for the responses. And I will definitely review that Chapter in the technical manual (thanks Dansket).

Not sure if it was posted before but I was wondering in the case of a patient who regularly comes in once a month and has an antibody (ours has a Anti-E, Jka) would you do a workup every single time the patient came in? Would you just do select cells? (E,Jka neg cells to rule out any new allo antibodies) If so, would you do this every month? Or, would you not do any panels if the antibody screen strength stayed the same?

We do a partial release after reviewing the flag and it is determined that the flag is not one that interferes with the WBC,RBC or PLT count. For instance a suspect platelet clump which may or may not be due to actual platelet aggregation, NRBC's, giant platelets, or even dwarf megakaryocytes. We would NOT do a partial release until a smear is reviewed for verification. In the case of flags for morphology review or suspect immature cells, we would manually release (like nziegler in the past) the hemogram portion of a CBC and "hold" the differential for smear review.

Maybe it stems from the fact that most specimens for Chemistry testing needs to be separated within 2 hours? Just a thought.

We do our antibody screen/ identification testing with GEL. Our ABO/Rh testing is tested with the tube method. Except for blood donors, transplant patients, and fetal testing why would it matter if you are weak D or D variant? I mean I know it matters but in regards to transfusing red cells or Rhogam administration? We used to report weak D patients as Rh neg, Du pos. We stopped testing for weak D several years back due to the amount of patients we tested for weak D (about 2-5 per year). Now, if a patient tests as D neg (tube) we result as Rh neg with the disclaimer: "According to current regulations, testing for weak D is no longer performed. This may result in a discrepancy between an Rh type done previously on this patient at this or other testing facility." (STD 5.13.2). I've also read that weak D types have been reported to make Anti-D. That being said, I like the fact that we save time and $ by being more conservative. It also help that we do our blood type testing with Tube method. Well actually although blood typing with tube is definitely faster than Gel, I'm not sure if costs less.

We got a notice (I'm guessing it was in April) that Ortho was NOT going to support our incubators and centrifuges soon. I'm not sure what our contract says but I'm certain our contract is up soon and that's why we got the notification.

Yes Mabel your reply certainly makes sense! It also takes a lot of time to try and find 3 cells to rule out, especially with antibodies to high incidence antigens..... Rant away!

We have the same protocol: Preferably rule out with homozygous cells, if those cells are not available with our current lot/s, three heterozygous cells are acceptable. We normally have 3 lots of indated panel cells to use. We may use outdated panel cells as part of a panel of "select" cells if indated cells of the desired phenotype are not available.

Hi all, Our facility provides Leukoreduced red cells and platelets. My question is: does anyone know the statistics on CMV transmission/infection if someone (who is CMV negative) receives non-confirmed CMV negative blood products? I've read that it is important to give CMV neg products to: a. CMV negative recipients of allogenic stem cell and bone marrow transplants. b. Solid organ transplant recipients. c. Immunocompromised patients (HIV). We have MD's ordering Irradiated / cmv neg blood products on "Leukemia" patients and Neuropenic patients which I thought was not necessary at all. Are we wasting time and $$$$$?