Rapundaa

We have been using the Galileo and Neo for 12 years. Yes we have seen issues with the Rh typing being positive on previously negative patients. Our protocol is similar to Dothandar.

Scott- What methodology are you using (gel, solid-phase?) We see a lot of equivocals with solid-phase and it can be very frustrating to weed through the reactivity to discover if a clinically significant antibody is there. We also see more equivocals in certain categories of patients (pregnant and some auto immune disease states). And as Malcolm has stated we have seen some of these equivocals become actual an actual E, C, Jka and several others! Sometimes going to an alternate method (we go from solid-phase to gel) can help because a patient may have a lot of non-specific reactivity in one method and none in another. Not the most definitive answer but we share your pain!

Same here since about the same year.

We are a Level 1 Trauma Center with extensive emergency, surgical, obstetrical, and outpatient services. Looking for motivated technologists, experience is a plus! Currently we have open positions for a full-time midnight shift and a part-time afternoon shift. These are dedicated blood banking positions (no rotation in other lab sections). The hourly rate is highly competitive for this regional area, excellent benefits as well. Our hospital is in Ann Arbor, Michigan. Please specify that you are interested in the Transfusion Service positions when completing the application using the link below: http://www.sjmercy.org/careers

We are a Level 1 Trauma Center, with extensive surgical, obstetrical and outpatient services. Looking for a motivated technologists, experience a plus! The open positions are for a full-time midnight and a part-time afternoon shifts. These are dedicated blood banking positions (no rotation in other lab sections). Our hospital is in Ann Arbor, Michigan. Please specify that you are interested in the Transfusion Service positions when completing the application using the link below http://www.sjmercyhealth.org/careers

In this case the donor will not be "on site". There is a surgery facility where the harvesting takes place and they would like us to provide units to keep the donor oxygenated during the process. The donor is anonymous and we will have no prior txn history.

Could you footnote (non-chartable) the control results on the antibody screen for manual testing? We use Cerner PathNet and we document control testing for antigen typing in the non-chartable section. We Keep manual testing results in a folder with the patients name (as for antibodies) and scan those into a special on-lie folder once every two to three years.

Remember that turn-around-time is based on how many specimens are running in advance of the new ones being added for the next run. Also remember that some analyzers will not allow you to add additional specimens if testing is already in progress (not continuous access). It's helpful to be allowed to cancel testing that has not already started (without loss of reagent volume) and add STAT testing.

Does anyone have experience providing blood to a gift of life organ donor? Do you receive a specimen and provide compatible blood based on serological testing or do you issue uncrossmatched O negative units? Have you ever experienced a transfusion reaction with this situation?

We considered doing this recently but because we are FDA inspected we didn't want to get into the whole "home made reagent" issue. There are a lot more hoops to jump through unlicensed sera.

I'm not entirely sure what you are asking... But why was antibody identification not done in solid-phase? Kidd antibodies are known to love the solid-phase environment, gel not so much. We have had numerous examples of Kidds that react in Capture and not in gel during our validation testing and since. It is always a best practice to be performing your identification in the same method as your screening. And that would extend to crossmatches as well.

We accept verbal orders in emergency situations. The expectation is that these orders will be entered at a later time into the HIS (mostly happens). The request is documented on one of these forms (attached) and it is stapled to a copy of the checklist that we use during issue of products. This form and checklist are stored with all the other Blood Product Request forms received via the LIS for 10 years. Request for Issue.pdf

The following are our criteria for performing a KBT: Order a KBT on an Rh-negative obstetrical patient for any of the following: post-delivery Fetal Screen test is positive, trauma during pregnancy (ordered by the physician), mother had a vaginal bleed, fetal death, terminated pregnancy, amniocentesis or CVS at > 20 weeks gestation, mother had a version procedure, and/or neonate is Rh-negative with a positive or invalid Weak D test, or Rh cannot be determined. At less than 20 weeks we issue one dose of RhIg without further testing, other than the type and screen. CarrieM has nicely summarized the use of the Immucor FMH RapidScreen if that is the kit you are using. Additionally at delivery, we use an on-line calculator recommended by the AABB to determine the amount of RhIg to be given based on the mothers height/weight: W:\AB\Bloodbank2\CAP AABB RhIG calculation\RHIGCALe.zip\

We have NEOs and the positive and negative controls are part of each set of AHG-xms run on the analyzer.

Same as ChrisW for 10+ years

We are part of a multi-hospital system. We can view the results of all the hospitals that use the same medical record system that we do. It is extremely helpful when patients are transferred between hospitals for checking recent results (continuity of care as stated by goodchild). Our less than helpful issue is that the LIS lets you view all units set up on a patient without differentiation as to their location. So sometimes it gets confusing that the patient may have had units set up at a sister hospital that were not released prior to his transfer to our hospital. We've learned to look for that as soon as we get the first specimen of a new admission. But again this is information you are viewing in order to provide the best care for the patient.

We are a NEO user (and prior to that Galileos) since 2006. The Echo photos are much clearer that the ones on the NEO screens so I am aware that Immucor states that your techs may interpret equivocal reactions. We treat all equivocal reactions as positives because the clarity of the reaction is not as visible on the NEO screen and because we have found at least a dozen significant allo-antibodies over the last 3-5 years that reacted weakly on the screen and we much more apparent on the panel. I would use a great deal of caution in interpreting an equivocal reaction as negative. I realize there a some populations which produce more equivocal reactions than others (in our experience prenatal and obstetric patients are frequent issues). You may wish to consider an antiglobulin crossmatch in cases where transfusion is necessary.

We also use the Sorvall CW2+ and have issues with the we cell button and overall a very wet interior at the end of a 4-wash cycle. But in that we only use it for DATs and LISS or saline workups (3rd and 4th priority in methods of testing) I doubt we will replace it soon.

We are using the Swisslog system and have for about 10 years. In general things go well but the system can get backed up during peak times of the day and tubes may not leave the station as quickly for OR and ER as we would like. If we are sending blood for a massive txn we try and encourage them to pick it up in a cooler so they have ice and they get all the products at one time, eliminating the problem that some may not get removed from the station where they arrive. Our carriers are for blood transport are foam padded so we have had to place notes in the tubes to remind staff not to remove the liners before sending units back (to avoid hemolysis). But it's a constant battle because other areas think the only was someone will open a tube is if they can see that there is something inside of it and so they remove the liners (and sometimes discard them). We now keep a supply of extra liners in the Transfusion Service so we can reline the tubes as needed. Because with the pneumatic tubes the units are no longer delivered on ice, it took some RN education to get them used to the idea that they need to have everything in place (consent, IV, pt temp) to basically be ready to start the unit as soon as it arrives (or return to us in 20 min). All in all its been a very efficient method. But when it goes down for contamination or service issues finding enough messengers to run the units becomes a challenge now!

You should of course remind your staff to observe the vial for hemolysis at least each time you do QC. Sometimes with weather changes and corrosion of the tips on the pipettes so that there is carry-over there can be hemolysis near the end of the period of use.

We also charge as "bill only" using the IRL charge sheets. And as mollyredone said "if you don't charge then CMS reimbursement will never change!

We also use Helmer Cleanbath (and have for quite some time) and we thaw a lot of plasma daily. The water bath gets changed monthly and barring broken units leaking out of their cover bags it lasts well for the month.

Ours is also the same as Teristella.

We gave up our RhIg about 10 years ago. It's stored in pharmacy. After the work is completed in the LIS we order the RhIg in PowerChart (the hospital's Cerner program) which prompts Pharmacy to issue. We can use one or more doses as needed. It's given an obscure pneumonic to keep the physicians from being able to locate it and order it without the appropriate blood bank work first.

Do not discount ? reactions. We have subsequently identified antibodies from these reactions (D, C, Jka). Anyone who reacts with a ? on the screen gets a repeat screen and a full panel. Granted most of the time this does not lead to a cliically significant antibody but then when it does... And we are in this field to go above and beyond. We use NEO (Echos big brother) and used Galileos for a number of years before that. We are will aquainted with the desire to make those ? reactions go away. I will try to attach my flowchart in a few minutes