BloodBankGuy

Hello, We are going to be moving forward with testing cord blood gases. We currently run venous gases and arterial gases on our ABL 800 series. Now since a cord gas is still technically a blood specimen, does this require a new set of validation? We are not running reference ranges with this, so I don't know if that would make a difference. Thanks for any input.

We have started to use AimTab. They are not FDA approved but we are using them as a LTD and they correlate perfectly with Clinitest tablets.

Thanks for the info!

We do not. There was a validation done on these 10 years ago when we first received these devices, so we were piggybacking off of that a little bit. And in us doing that it brought up a lot of discussion. So far the consensus is we went over and beyond what we should do and biomed checks are sufficient.

Hello Everyone, Need some guidance on validation of blood warmers. Recently our clinical engineering bought 24 new blood warmers, same model and brand of what we have already used and validated. We have just recently validated 6 of the 24 new ones with running blood through them and taking whole blood potassium levels at hourly intervals. The question we cannot agree on is do we need to validate every single blood warmer or is the 6 that we have done a sufficient sampling to be able to make a blanket statement that the warmers are ok for patient use. Anyone have any evidence based answers to this? At this point I'll take just some good advice! Thanks in advance.

If you attend any Medicare billing conferences they discuss this in detail. You can only charge for an antigen typing to one patient. Now if you want to charge it to the patient you initially screened OR the patient that is receiving it if the first didn't need it that is fine, but charging bothing for something you have done once is a mischarge. At least that is how it is discribed.

Actually if you look further CAP TRM.40800 says, "There is a mechanism to ensure that Rh immune globulin is administered to all identified candidates within 72 hours of an Rh alloimmunizing event, whenever possible" So blood bank does need to be involved in distribution some how. This cannot be just left to Pharmacy and nursing staff. Whether its a followup daily or something else. If you are not distibuting RhIg, you need to be aware of who is and who isn't receiving RhIg from Pharmacy.

We use "Titer too low to measure: Enhancment reagents used for antibody identification are not recommended for titers." We do not enhance our titers as we do antibody identifications to prevent falsly high titers. We treat it as in vivo where we see how it demonstrates without the addition of enhancment reagents.

Thanks for the replies. I have never heard of anyone doing a comparison like that and I don't know what the real benefit is, but just following up on a request. But I will contact financial and see what reports they can get me. Thanks again.

Hello everyone, Looking for some help/direction based off of a request made by my Medical Director. Do you have a way to track blood utilization in a macro fashion rather than just micro. Not looking at individual patients and their clinical indicators but looking at severity indices in a hospital system as a whole. For example if a severity index for a hospital is 1.3 the average number of transfusions for a patient should be “x” amount. Also, if that number goes up and goes down what is the number of transfusions that should be followed? Request comes from medical director to see if there is a number that hospitals should be shooting for, for average transfusions based off of this variable. Thank you. AABB Tech Manual basically just hits the micro portion of blood utilization(hematocrit, clinical indicators) on certain patients. From what I read there isn't much concerning macro utilization. Just looking at the amount of transfusions per 1000 patients with a severity index of a certain number. Any info or direction to look would be helpful!!!

Our blood bank policy is if there has not been a transfusion in 3 months we would not do the elution. Granted if you do not have any previous history on the patient you are relying on their word, but its not like you are asking if they took a certain medication that they may or may not remember. Most patients, will remember if they received a transfusion or not. Now I have some older techs that will still run one to see, and if we have a patient that looks to be a WARM auto we will run one, but in general we don't unless proof of transfusion But there is a small possibility that you have bad intel as goodchild said and you may miss something. Kind of a judgement call.

I was meaning the ABO discrepency as we had a previous and the current ABO did not match. The only thing I cannot remember off hand was the back type results. But I do believe that, like the OP, it was non reactive.

Interesting enough my hospital had a situation just like this less than a year ago. We were not informed of the bone marrow transplant but saw that the doctor was an oncologist and when we typed them (previous and we saw they were now an A, we thought we needed to do some digging. When we finally found out that they had a transplant we gave them O cells as we could not fix the ABO discrepancy even though we had a reason why. As Shily said, O cells are not rare so we kept as such to not cause any potential effects since no one had ever experienced something like this before.

Yes, there was not any negative results from this.

Our pathologist does not have input in the identification of antibodies and they do not review the records after. Significant/insignificant is made by the supervisor (Me) if there is any question as to whether it is or not. Granted it's easy as 98% of antibodies are significant that are identified on a daily basis. But as I said no pathologist comments on antibody identification.

Yeah, with 1+ reactions you could just have a weakly reactive antibody that doesn't react in tube and that would be expected since solid phase is much more sensitive. Which then comes into the question on "How sensitive is too sensitive?" because if we were still doing tube we wouldnt have seen it. But times have changed and we do have a more sensitive method, so run the panel and if it follows a pattern you know. There is still a change of sensitization if you dismiss a weak reacting antibody on echo and just transfuse any blood.

and AMcCORD, my staff did not know they were going to rehang the unit. She thought they were going to discard the unit on the floor, which they did not. If she knew they were planning on rehaning she might have been more proactive on not letting him leave and she would have called either more or the pathologist. From the way the nurse talked it sounded like they were going to discard but then when she received the transfusion paperwork back she saw time and amount transfused edits and called to ask why. Thats when she found out.

TBOSTOCK, we are accredited but the physician did not call a transfusion reaction. We actually got more info the other day. The nurse misunderstood the doctor. The doctor told him to stop the transfusion, give meds then restart in an hour. He took it as he was calling a transfusion reaction and stopped and unhooked. Still not a kosher situation but everything was cleared up, the nurse knows he didnt do it what he was supposed to do correctly. And I agree that he shouldnt have left the blood bank with that unit, but lab staff have got in trouble by questioning doctors and nurses before so they hesitate to take something out of someones hands.

Yes SMILLER but that is talking about reissuing. At no time was this unit reissued. It was never returned to blood bank, so this would not apply to this situation. We would never have accepte this unit back under the current conditions of it being spiked. The nurse never handed over the blood when he walked down with it.

When i say they brought it back to the blood bank, they walked into the blood bank but my tech did not take the blood, the nurse had the blood when he walked in, and it never left his hand and he took it back to the floor. This was just an unusual situation and she didnt think to take the blood from the nurse, granted it would have been best to. But it was not "returned" and then reissued that would be a huge violation. We cannot prove that the reidentification occurred or did not occur, its his word against ours with that. And the unit was transfused in the 4 hours. Bacterial contamination and the risk of transfusing the rest on the incorrect person are our two biggest issues with this. But as I said, I have not found any documentation where it says do not stop and unhook a transfusion and then rehang and start it again. I agree, this has bad written all over it, just too many potential safety issues that are being discarded, but what is my staff suppose to do, get in a fight with a nurse if he won't hand over the blood. Disturbing is the nurse supervisor AND physician ok'd the unit to be rehung!?!?

Hello all, I have had a unique situation occure the other day and I am having trouble finding any resources to prove my suspicions that this was not kosher. Situation was a nurse called a transfusion reaction and stopped the transfusion and brought the blood down to the blood bank. We then questioned if the Dr called the reaction, which he/she did not. After calling up to his nurse supervisor they decided the Dr was not going to call the transfusion reaction, just administer antihistamine and tylenol and then transfuse another unit. Everythign is ok until this part... When the transfusion paperwork came back, a new stop time was added on to it and the amount transfused was changed. When my tech called up they informed her that they rehung the unit that they originally brought down for the "transfusion reaction". The nurse said that both the nurse manager and the physician OK'd them to rehang the unit. Now that just seems off to me, granted there is risk in transfusing a different unit of blood, but there was known risk in rehanging the unit. I am trying to look through the technical manual to see if there is anything regarding this but I have never experienced something like this before. All information or opinions welcome!!!

Yeah, early this year they had a problem with their main manufacturing plant and it really cut down the amount of product they could produce. For a while I believe everyone was on a strict, reduced shipmen of product that had everyone really worried, at least my hospital was. Some of the product that came out, if your sales rep was open with the information as mine was, they would give us a heads up on some lots that were showing false positive reactions. We had a couple lots that were effected which was not fun since we didnt really have our normal stock of product to switch to. They seemed to get it all fixed and there hasn't been any issues that I am aware of recently. If you do happen to get a lot that you are seeing a trend of a lot of positive reactions, call your service and they should be able to tell you if there have been complaints about a certain lot number. And if so they will send you out a replacement lot.

If you get your shipments from Red Cross, or whomever you may, just call them. I know with the ARC platelets are supposed to be rotating unless in shipment, but are supposed to be placed on a rocker when delivered. As JEM said, the fact that there isn't anything to support the practice of "resting" is your literature there. Even in the current AABB technical manual ed 17 pg 272-274 it outlines storage requirments for platelets, requiring constant gentle aggitation. No mention of "resting"

Yeah very common issue, our hospital policy is very simialar with EDibble. These also could be cold antibodies that are being picked up on the more sensitive ECHO and not in tube. If we repeat with the tube panel, both PeG and LISS, and get a positive reaction in 37 or AHG phase, we will do a full panel with that potentiator, if it is just garbage (cold reactive non specific) we will do a cold panel and call it a cold. WIth using all methodologies solid phase is by far my most favorite to work with, with this situation being one of the only interferences. Develop a flowchart around it and you will be good to go. Just make sure you can also identify High Freq Ags as well with it.

Possiblity of it being a -LW is low, but we did not have O Neg cord cells to test against. Patient was knowledgable of medications given since she was given RhIg for ITP before. That was not her current diagnosis but her last injection, as stated, was years ago so possibility of -RHO is very low. A unit given that was a D Variant could be a good possibliity if there was enough -D in the plasma, but my only thing with that is there was no positive DAT. Granted in low volume there is a chance it could be positive or negative. But that seems probable. With out send out testing there was no way to determine and since the DR didn't want that, possible -LW with cannot rule out -D was resulted and only Rh Neg products given for safest transfusion for patient. Appriciate all the input.