kelliott

Our goal has been to find out the source of the reactitiviy. If the cell is double dose for the Jka antigen ...we have found in some cases anti-Jka. If the cell is P1s we have identified anti-P1, if the cell is double for the M antigen we have iin some cases identified anti=M, in some we have identified anti-E using ficin gel technique, in the rest we have identified anti=Bg. There is almost always a reason for the reactivity, rarely do we find non specificity. It takes extra effort but in the long run it pays off.

All 3% cells, regardless of the manufacturer must be diluted with MTS diluent 2 when used for Gel antibody detection or identification.

You should not spin a second time. You will get false negative results doing that and in addition that action is not following manufacturers directions. You should go back and look for the antibody causing the 1+ reaction on your screen cells, rather then trying to get rid of reactions. We found that Ortho's prediluted cells have a high degree of specificity but also a high degree of sensitivity. If we suspect a problem with the ortho cells we work with a 3% panel diluted to 0.8%.

I am a beta site for Helmer for a non bleach product - microcide. After using Sorval cell washers for 35 years at multiple institutions and never bleaching the systems and never having a problem I have recommended to the manufacturer monthly cleaning with microcide. is adequate. Tesiting is not yet complete. Stay tuned.

How many of you have seen an increase in the number of false positives beginning the last 8 months or so? We have been frustrated with this and the slow immucor response to resolve this problem. We opened a new lot two weeks ago. The first 7 patients had positive fetal screen tests and no fetal cells seen on the fetal stain. We have tried all that the manufacture has suggested: extra washes, buffered saline, alternate blood collection tubes. We have made no changes since implementing this kit 3-5 years ago. Immucor has relocated the manufacture of the kit and it was around that time we started noticing false positives. Yesterday during a student training session, a D neg male sample was selected to ensure we would obtain a negative FS test...it was positive. Has anyone found a solution for this very frustrating problem? It will be awhile before Ortho has a kit available...but they are working on one.

After ID of anti-D in D negative woman of child bearing age we investigate for RhIG administration. If RhIG has been admininstered within the previous 5 months [gel technique used for ABS] we report "results consistent with RhiG administration, administered XXXXXX."

I am looking for a compact stand on wheels that will hold the computer in a side slot, the printer on top and also have space for the UPS. Does anyone have any suggestions on where to find one? This has to fit under a counter. We have just installed a ProVue and would like the associated computer equipment stored under the counter where the ProVue sits.

Hi Mabel, HBB requires that we type the donor RBC's for the A1 antigen if the patient has the antibody attribute. I'm not sure if this is related to how the antibody is defined in our system. If there is no connection to the classification table unfortunately HBB requires that we type O units for the A1 antigen. Fortunately this isn't a common occurrence.

Hi Mabel, welcome to the Pacific Northwest! I might be able to help you. Our blood supplier is 4 hours away and they have worked with us as our NICU was implemented. Our NICU is not the highest level...I think we are level 2 at the moment. We transfuse very few infants at this point but when we do we order what PSBC calls an assigned aliquot...they dedicate one AS-5 unit, leukoreduced unit to the infant then divide into 8 pedi packs. When they ship they irradiate the number of packs we request. Our neonatologist [OHSU based] will use an irradiated AS=5 unit for up to 28 days. They know how to manage the potassium problem clinically so are not concerned...if it is a small volume transfusion..most are. We would never give out of group plasma for platelets ...if we didn't have plasma compatible platelets we can get from across the river. The only thing you could do is as you have said...medical decision at the bedside unless the problem was known before delivery and you had some time. We keep AB FFP from same donor and AB cryo. Chartmed filters are great. We don't have a sterile docker....for us it isn't practical at this point because we have so few transfusions, the maintenance, QC, training would not be worth it..I wouldn't be able to keep everyone competent on its use. Using the pedi packs precludes the need for that at the moment. When volume increases it will be more practical.

If I understand you correctly the mother is weak D positive...on a predelivery sample. In that case you would expect the fetal screen test to be positive because the mother is weak D positive. The fetal screen reagent is an anti-D. You confirmed there were no fetal cells in the mothers sample with the KB test in the event the predelivery weak D test on the mother was in error. Unless using molecular testing to define whether the mother is weak D or partial D most are erroring on the side of safety as ou did and administering one vial of RhIG for a negative KB test.

I have learned that the manufacturers of the Ultra CW (Switzerland) do not allow use of bleach to disinfect the device because it is so corrosive. I have contacted Helmer about this..they are working on it.

Would anyone be willing to share their maintenance protocol for this device. The manufacturer is recommending bleach which I will not use because of the affect it has on the S antigen. Helmer at this point doesn't recommend any substitute. Is anyone using Microcide SQ? Weekly rinse seems pretty aggressive. Has anyone using a monthly or quarterly rinse schedule noticed any problems with serological test results or adverse affects on the device?

Spinning a Gel card reaction twice invalidates the original reaction.

When a trauma patients is ID'd with Jane/John Doe or similar emergency ID, sample collected, crossmatches performed..then name is changed how are you managing the chain of identification? Are you collecting a new specimen and repeating the testing? Does your patient registraton wait until the need for blood has passed then change the name and a new sample obtained? 5.11.3 states "the transfusion service shall confirm that all identifying information on the request is in agreement with that on the sample label. In case of discrepancy or doubt, another sample shall be obtained.? Once the name is changed, the name on the request changes. It seems to be in compliance the only alternative is to recollect the sample with the new ID.

2nd sample: the decision to implement a typeck sample for non group O patients should be based on the individual facilities track record. We tried fo 8 years to train the ED, FBC and respiratory therapy blood collectors that the patient needed to be wearing an armband at the time of sample collection, that they actually needed to look at the armband and that they needed to label the tubes at the bedside. The error rate continued at the same rate so that is when we implimented the typeck system. We have been using it for nearly 2 years now and have prevented 2 mistransfusions. It works for us and we feel we have finally achieved a level of safety we are comfortable with. As for using 2 different D reagents.... The two D reagents we use contain different anti-D producing clones. This allows us to recognize a potential D variant versus a patient with a weak D antigen. Once we detect an individual who reacts with one reagent but not the other by direct test we investigate further to see if it is prudent to label the patient as D pos or neg based on age i.e. child bearing age or not, female versus maile. Again, there is no right or wrong way ... but rather what works for your transfusion service.

Unless things have changed dramatically coombs control cells are all D + coated with anti-D. secretor versus non secretor - individuals of the Le(a+b-) phenotype are non secretors.

The recipe for weak D mentioned above sounds more like a good sample for a mixed field reaction. If you use that for weak D - how then will you teach them the difference between weak D and a mixed field reaction? For the A2 with anti-A1 - try using an A2 that is a nonsecretor. Ask your blood supplier - or reference lab to send you some examples of weak D. That has worked for us. A good recipe for a weakly positive DAT is to take 10 mL of a 5% red cell suspension of D positive cells. Add 1-2 drops of human anti-D, incubate for 30 minutes at 37C, wash 5x and resuspend to 3-5%.

I would appreciate hearing the details of your process for performing pretransfusion testing 30 days prior to surgery-negative antibody screen and no recent transfusions. How do you manage the armband? Does that patient retain it or is it kept in patient registration until day of admission. On the day of surgery do you collect a 2nd sample for repeat T&S or just ABO/Rh? Do you store the plasma frozen or liquid. Are they filed alphabetical or according to draw date? We currently collect samples for presurgical patients no more thatn 7 days. Our orthopedic group wants to implement a new process where the patients have the pretransfusion testing performed with the CBC etc. which is done 1 month prior to surgery. Anyone willing to share the details of their process would be very helpful. kelliott@swmedctr.clm

We have a transfusion order form that contains transfusion indications - I would be glad to share if you send me contact information.

I hate to say it but I have been in the field long enough to have seen reports of coolers left in OR for a 2nd case years ago. So the report of a member on this forum of that same scenario does not surprise me - only validates the concern I have about that process. Thats why I have been ignoring the JCAHO recommendation about blood in OR refrigerators. OR refrigerators work well for us - we limit the number of units in the refrigerator and with implementation of the electronic crossmatch we will be educating surgeons to order blood for most cases on demand thus fewer units in surgery. Having said that we still monitor each individual donor unit with safe-T-vue temp monitors. Some anesthesiologists will request that a unit of blood be removed from the refrigerator, take it to the operating room and then return it to the refrigerator. We don't know how long the unit has been at RT but with the monitors we catch the units that have exceeded 10 C. For those of you who use coolers routinely Williams Lab has manufacturered safe-T-Vue temp monitors for the 1-6C range. They will be sending out the information on these next month. They are user friendly and their use precludes the need to have the OR record temperatures.

I guess I am not surprised about the label adhesive regulation. Because our blood supplier has an unconventional product code system we have been forced to create some of our own barcodes for product codes. Rather than apply them directly to the blood bag we apply the barcode label to a tie tag that we attach to the unit. That is one way to use an Avery label and remain compliant.

Until we implement ISBT128 near the end of 2006 we are attaching a tag to each modified unit. That tag contains the new product code - eye readable barcode, our Facility ID and FDA registration number - all barcode and eye readable. We cross off the old expiration date/time, storage temp and the words fresh frozen and attach a label with the new expiration date/time, storage temp and product name. After ISBT 128 implementation we will retain the above procedure for use during our blood bank computer downtime.

we require the typecheck on a 2nd sample for all crossmatch candidates for the sole reason of preventing an ABO hemolytic transfusion reaction. Despite focused attention to sample labeling since 1998 we still have an unacceptable number of WBIT (wrong blood in tube). That is why we moved to the practice of a 2nd sample. If we don't have the typecheck sample prior to the need for transfusion we crossmatch group O red cells. We are able to find a sample about 10% of the time in the main lab so spare the patient a 2nd stick. We rarely have to use group O for no group patients. Implementation went very smooth.Performing a 2nd blood type on the same sample does not protect against cases where the wrong patient was collected or the wrong labeled applied to the tube.

Safe-Vue will soon have available a temp monitor with a range of 1-6C. They currently have one that monitors 1-10C.

I believe the mechanical barrier system is the Blood Loc system. No armband system will be 100%. Your current system does not preclude implementation of electronic crossmatch. However, you might consider implementing collecting a blood type using a 2nd sample collected by a different phleb at a different time. We implemented this 11 months ago. and have prevented 2 mistransfusions. Implementation went smoothly with transfusion committee and medical staff support. I had much guidance and support from two facilities with successful implementation.