Shaundrey

When our computer is down, we have a place on our downtime card to indicate that the history check was complete. If you have the FHR print-out or computer, I would have the techs document on the downtime record or card that a history check was performed and the computer code that would need to be entered when the computer is back on line. The FHR print-out or computer should be enough for you to be compliant with the 12 month rule since it has the blood type of record along with the special requirments and antibodies.

At my previous hospital, we had Cerner Classic then Millennium and the Free Text History report (with a daily upload) worked pretty good. I am now at a hospital that uses Mediware's HCLL product and the Automatice Patient Backup Card (APBC) is better because it updates every minute. As far as regulatory, you have to have some kind of documentation that shows you actually looked up the patient history. Both places where I have worked we had a test code for History Check (you can have any canned comment you want). The tech performing the testing is responsible for answering this field and are held accountable for performing the history check. If the history check is not completed and the patient has an adverse reaction because of it, the tech answering this test is held accountable. HCLL does check the current ABO/RH & antibody screen results against the patients history but not antibodies. If the antibody is no longer demonstrating (which is what we want to happen) without looking up the history, you will not have a good way of knowing the antibody was ever there to begin with. If the patient has special needs, you need to check the history and make sure this is satisfied. Some computers check the products for special needs at the time the products are set up and some check at the time of issue (this is too late). I think you should way the effectiveness of your current process to see if you are meeting the CAP standard. It would also be good to check with CAP to see if your current process is acceptable. As an AABB inspector, if you are not documenting this manually, as a comment on the patient or with a test code that says you checked it, I would say that you are non-compliant.

For our MTP's, on the 1st pack we issue as emergency release 5 RBC's and 5 Liquid Plasma's. We use manual tags that we pre fill out with the donor information and add the patient information when we get the call. The segments are already attached and we put the date and time that we issue them on the tag. We continue this process until we get a sample. Once we get a sample, we stay 2 packs ahead and post issue in the computer after the runner has left. This keeps us from getting bogged down with the computer at the time of issue and we always have products available. The person issuing the products does the final check before the products leave the BB. This is all outlined in our SOP for massive transfusion protocol and emergency release of blood products. When they are not in a mad rush to have products, we will issue in the computer if time permits. We still have the issue of anesthesia not checking the blood products but that will forever be an ongoing problem for us. I just write them up every time it happens.

We are a level 1 Trauma Center with over 800 beds and our MTP process continually changes. We currently only send 5 RBC's and 5 Liquid Plasma or FFP/Thawed Plasma products up on each batch. We send platelets up with every third batch and place a sticker on them that says "Do Not Refrigerate". We don't do any cryo until they tell us (this helps with wastage). The biggest problem is always going to be nursing compliance with products at different temperatures. I file an incident report for every product wasted due to nursing errors and now I put the dollar amount that is lost due to the wastage. I only wish I could charge that wasted product to the nursing unit instead of BB eating the cost.

We use the computer date and time which is 120 hours. We generate a lot of exceptions when we convert to thawed plasma and extending the time to 2359 is not worth another exception.

We choose not to take units with alloantibodies. Our blood center keeps trying to give them to us but we keep saying no. I got one in for a patient once and even had the unit washed to remove the antibody and the unit was incompatible with several patients. There I was stuck with an expensive product that I couldn't use on anyone.

L106, 1) It was not the same tech each time. It happened with 3 different techs. 2) Yes, 3 cases total where each patient developed anti-c. 3) These were all delayed reactions because each patient was transfused and within 14days (one within 3 days) presented again with a positive screen, stronger than before, and they received units that were positive for the c antigen. I know it may seem like over kill to give c negative when they haven't developed the antibody but when you have a high population of sickle patients like we do and many of them respond and make antibodies, we feel it is best to minimize the exposure as much as possible. Unfortunately, they also hospital hop and it becomes hard to manage them so you do the best you can.

We also type for c when the patient has anti-E. If the patient is c negative we give c negative units. We have had 3 patients in the last year where the patient had anti-E and the tech did not type the patient for c or screen the units for c and the patient later developed anti-c because they got transfused c positive units. (delayed reaction)

1. Albumin - Pharmacy 2. Clotting Factor concentrates - Pharmacy 3. Rh Immune Globulin-intramusular - BB 4. Rh Immube Globulin-intravenous (WinRho) - Pharmacy 5. IVIg - Pharmacy

Thanks everybody for the responses. I'm not sure where this procedure came from and neither did one of the long term techs (she has been here close to 30 years). Since we are a primary gel use site, we are going to lose this 1:4 dilution in the tube.

Currently, when we have a patient suspected of having a passive anti-D, the techs perform a 1:4 dilution and repeat the antibody screen. If the 1:4 diluted screen is negative, they verify the administration of RHIG and call the antibody passive anti-D. This is a procedure that has been in place for approx. 10+ years and I don't like it. I couldn't find any literature or documentation of this beeing acceptable practice (I checked several old Tech Manuals from the 1980's also). Does anyone knows where this practice may have come from. I come from the school of ID all antibodies using the traditional panel method and verify the administration of RHIG before calling the antibody passive anti-D. One facility that I worked at we did a selected cell panel with a minimum of 6 cells. Our D+ cell was always Ror with the remaining cells being negative for D and homozygous positive for all other major allos (2 hetero Kell cells were used if no homozygous cell available). If only the Ror cell came up positive, we verified the administration of RHIG and then called the antibody passive anit-D. If the RHIG was issued by our facility, then the selected cell panel was performed. If the RHIG was not issued by our facility, a full panel was run. I am in the process of updating this procedure (and all procedures in the department) and wanted to know how others out there in BB land handle the identification of passive anti-D.

I agree with you Malcolm. We do not rule out on heterozygous cells unless it is Kell and we don't have a homozygous Kell cell on an indate or expired panel. In the case of Kell the techs have to have 3 heterozygous cells to rule it out. We have seen many times where someone has ruled out on heterozygous cells and missed an antibody because of dosage. With a large sickle cell population this is not good.