seraph44

We only perform the immediate spin test for confirmation of our incoming Rh negative units.

What about multiple antibodies? Sometimes we have 2 or more antibodies present and the screen cells, plus the two panels we carry are not enough to do the rule outs. Would this be considered a rare?

We would call it "Least Incompatible", because we were told to do a complete XM on several units. We would usually see variance on the reactions and would pick the least incompatible units. We would do a complete XM with the non-absorbed plasma, pick our least incompatible units, and complete XM with the absorbed plasma.

I looked up the CAP requirement TRM.42550: Storage Temperature Range Corrective Action- "If the proper storage temperature range is not maintained (inspector will check 4 weeks of recordings), there is evidence that timely corrective action has been taken, as well as documentation of the disposition of any affected components". I would say that I have enough evidence to say temperature was within range, but I don't have the continous charting or temps every 4 hours. I was worried about discarding units based on not having recordings at least every 4 hours. I feel it's like a pregnancy test, maintaining the temp range colder then -18 C is the qualitative ( In this case, the Freezer is pregnant). Knowing the actual temp is the quantitative (We don't know the specifics). Regardless, Freezer is pregnant = Temp range maintained. I will be printing a list of the inventory to attach to the variance. No need to discard units. I hope you all agree.

Just had an issue happened today and I really don't want to waste these products. Our Blood Bank Refer and Freezer are monitored once day with NIST certified thermometers. These thermometers also have a minimum high and minimum low display to announce the highest temp reached and lowest temp reached by the thermometer. In addition we have weekly charts, an alarm that goes off in our ER and we check daily, plus 24 hour staffing. This morning the tech realized she did not tighten the screw to the recording chart well enough. Meaning we now have a temp taken yesterday and a temp taken today, which are both within range. No alarms were activated, plus we have a urine cup container inside the Freezer that has a penny Frozen on the top. This should indicate any thawing if the temperature gets too warm. That also was satisfactory. Help, can I save these units since I don't have continous monitoring recorded, but no indications of temp failure were noted?

Hello All, I got two NIST traceable thermometers in today one reading 21.0 C and the other 20.1 C. they are both perfectly acceptable according to manufacture specifications. If I happen to run into an incoming shippment of platelets that reads 20.2 C on the 1st and 19.3 C on the 2nd, will my 2nd thermometer render my platelet shipment unacceptable? When I used to calibrate glass thermometers to the NIST, I would label it to reflect adding or subtracting 1 degree if the reading was off by 1 degree, in order to match the NIST. I was wondering if that can be done with the electronic thermometers; they provide a certificate with the NIST reading and with the instrument reading at the time of calibration. I need one of the thermometers for my incubator and I suspect the same thing can happen there. If the actual temp is 37, but my reading is 36.1. Since my range is + 1, I can see it being a problem if my actual temp is 36.2 per say, and my thermometer is reading 35.3. Technically I'm within range according to the reference thermomether, but out of range with the instrument. Any input on this?

Where I used to work previously we had 2nd tech checks and it eventually got to a 3rd tech check. This was an not the right thing to do. More tech became, comfortable that another tech would catch a mistake and more errors emerged. We went down to a 2nd tech to verify T&S and T&C. This we found to be a better approach; it also showed the benefits of having a second tech, because several mistakes are caught. The 2nd tech I like, It gives me better peace of mind. However, in a small facility, you don't have that luxury and must find other means. Where I am now, there is no second tech, but we do have an LIS that will cover most clerical errors. Catching mistakes is great, because it exposes our weakness and provides and opportunity for improvement, but not always will it be resolved by adding a step. Sometimes we must retrain the individual.

We also use manual gel (assuming you're talking about the screen) and tube ABO, No second tech, and require a second sample to give type specific. Our LIS will catch any clerical input and prompt before verifying results. Most LIS are built like that, so I'm guessing the LIS you have might be a DOS based system or completely manual system that does not include that type of logic or they are being transcribed in the system incorrectly. Either problem, in my opinion, is solved with proper training. Sometimes people do not have the BB background and are put into working BB independently too soon. When dealing with multiple patients, I like to alphabetize them in my rack, my centrifuge, and my LIS. This helps with the mixing up of patients.

A little of the main subject: I was recently inspected by CAP and the inspector mentioned that I should be doing an extended XM not only with my IgG card, but also with buffer cards. Our current process for the extended/full XM is to perform the IS by tube and we have the option to perform the AHG by tube or gel using anti-IgG. She mentioned something about reactions at 37 degrees in tube = AHG XM reactions with buffer cards. She could not find any sustaining evidence and she left it as a recommendation. Does anyone practice the technique she mentioned? or the technique I currently use? -Thanks

OK, that's what we've done so far.I was just wondering if that is evidence enough to show that there are no clinically significant antibodies or we should've done a panel as well.

If you get a type and screen and have a positive ABSC that needs to be sent out due to panagglutination, do you send out if the patient gets discharged? or if the doctor confirms no blood will be needed? We are for profit hospital, and I expect sending it to the ARC will cost somewhere >$3K. What is your input or practice for this scenario? -Thanks

How do rule out Rouleaux, when reacting positive in Gel? Do you only do tube screen with LISS and a saline rep technique? Do you run a panel in LISS? any comments would be greatly appreciated. Thanks, -Serafin

Is this a specific lot #? or random lot #s?

Hello, I currently use Gel as my primary method. A tech on the weekend got the following: 3 cell screen: 2+ for all Gel panel A (11 cells) 1+ and 2+ reactions with the exception of 2 cells and the Auto control that were neg. Gel panel B (11 cells) 1+ and 2+ reactions with the exception of 3 cells that were neg. No pattern of single, multiple, multiples with dosage. Wells appeared to have thin sheet on the top of the column. Tube method immediate spin revealed Rouleaux and AHG results were negative. Saline Rep was done at immediate spin and reactions were removed. Is this a good enough, to prove that Rouleaux is causing the reactions in Gel? What would you recommend to indicate reactions are Rouleaux and not something else? Thanks, -Serafin

Hello, I am currently working in a small hospital in North Carolina as the Blood Bank Lead. I have over 10 years of Lab experience, over 8 of those in Blood Banking. Most of my experience was gathered at the Naval Hospital in Portsmouth, VA. I am now in a leading position and it is exciting and stressful at times. Not having my technical supervisor at the palm of my hand is a big change, but I do like the challenge. This site has given me a lot of information when I hit a dead end. Thank you all for that!!! I'll be posting some questions shortly and hopefully join some discussions. Serafin