TreeMoss

We supply blood to 5 helicopters around this area. If blood is given in flight or if the units are wasted because they are out of temperature for any reason, the charge is passed on to the helicopter service. We document that the unit was given to a patient and then we change the status of the unit to a Final Status in the computer. Apparently, the helicopter service charges a flat rate to the patient no matter what is used, so the charge for the blood is just part of that service. Anne

Can we call you Scott "Charles Dickens" Miller?

If we've done a type and screen pre-delivery, we only test the mom for a feto-maternal bleed on a post-delivery specimen. We don't repeat the antibody screen in those situations. If there was no type and screen done pre-delivery, we will do the complete workup post-delivery. If that antibody screen is positive and matches the pattern of anti-D, we check with the nurses to see if the patient received ante-natal RhIG and when. We report out the positive antibody screen and comment that the positive results are probably due to Passive anti-D from RhIG given (date). We also comment that the antibody will be identified if requested by the physician. No physician has ever requested that we do an antibody identification on these patients. I did an inspection once where the blood banker was working up a patient who had anti-M. She choose only selected cells that were M negative to do the panel on in order to see if the patient had formed any other antibody. This is not currently our practice, but I was interested in that procedure. That would be the same as testing those cells marked with @ on the panel to see if anything besides anti-D was present, I guess.

Check the package insert for the Diluent. We look at the diluent for clarity and expiration date and make note of that on our daily QC sheet.

We simply add the new packed cell to the original TS specimen -- adding a comment to indicate what we did. We "NP" the IS and gel crossmatch results and result as Compatible. We write up a credit for the crossmatch and the packed cell and only charge for the aliquot and making the aliquot. We also do electronic crossmatches here, but we don't perform a crossmatch at all on the baby if the antibody screen was negative. We also do not use cord blood for any transfusion purposes because we have found that the specimens are not labeled at the time they are collected. We only use the mom's specimen for the baby's antibody screen if the baby has a positive screen -- otherwise, the NICU collects a new specimen for our testing on the baby.

Amazingly enough, our last FDA inspector was pretty laid back. I was surprised, to say the least. That inspection was so enjoyable!

We have clear plastic divider racks for our blood bank frig shelves that keep the units upright without having to use holders. The last two frigs we've purchased have not had these racks available -- they have two sides to go across the drawer and two to go from front to back! We just trim down the old racks to fit in the new drawers and hope that they continue to work well. It really helps to view the units when they are upright. It used to be a lot easier to see the expiration dates before we switched to the ISBT128 labeling, but we've adjusted.

Good suggestion -- I'll have to check in to that.

No, we don't have a centrifuge to spin blood down, and our FDA registration doesn't cover that -- although we could update that. Anne

If the units are from our blood supplier (ARC) and we have the correct paperwork with correctly transported units, we will put the units into our inventory and use them. Anything from another supplier gets discarded. ED folks are instructed to bring any blood products transported with a patient directly to the Blood Bank. If necessary, we will issue units as "Uncrossmatched"; otherwise, we collect a new specimen and crossmatch needed units. We will also let the original facility know if we discarded their units.

We will do a pre-darzelex blood type and antibody screen as well as antigen-type the patient for all antigens that we have anti-sera for. When transfusion is needed after the darzelex is started, we will use phenotypically-matched packed cells. If the patient specimens don't come until after the patient has received the drug, we send the specimens to our Red Cross Reference Lab buddies to work up for us. They use the DTT (not DDT!) and antigen-type the patient to provide information for our future use.

I think our major concern here is wastage. However, our recent Level II Trauma inspector said that was probably not a valid reason not to start using whole blood!

Thank you for answering in such an explanatory way, John and Scott. Nothing more needs to be added, in my opinion. Many folks just don't have an understanding of the education level required for our jobs as Medical Laboratory Scientists.

We also add a comment that baby may be re-tested with no charge at the 4-6 month time. Have not yet had anyone come in to take us up on that offer!

We do this test on all Rh (weak D) negative cord blood specimens from babies with Rh negative moms -- just to make sure that it is baby blood and that mom doesn't need RhIG.

The unit was just sitting on the counter.

We do 5 transfusion observations per month as part of our Blood Bank Quality Improvement. There are several CAP items this could fit under -- between TRM.41000 to TRM.41300.

That is definitely what we do here. We do not have what we would need for an autoabsorption, and our ARC Reference Lab folks serve us well.

We did a validation a few years ago where we set a unit on the counter in lab, ICU, and one of the other patient locations. We took the temperature of the unit every 5 minutes. We found that the temperature was within range in all locations tested for at least 30 minutes, so we validated our 30 minute rule.

Yes, you do need to crosscheck the kit. We test the new kit against the old kit -- use the cells from one kit with the anti-sera from the other kit. We just record our results on our regular QC sheet for the FMH Rapidscreen test.

We use a blood cooler for PCs and FFP taken to the OR. The units are logged onto a log sheet that accompanies the cooler. The log sheet has a sticker with patient ID. When we deliver the cooler, the person we hand off to has to have something with the patient ID and we check two identifiers before giving them the cooler. We also issue the units to the patient so the OR folks can use BCTA (barcode-enabled transfusion administration) to transfuse the products -- only one nurse and the computer verify the units. Like the others, if emergency blood is needed, we prepare the uncrossmatched units - writing the information on the cooler log sheets -- and deliver those units to the OR along with the paper for the physician to sign taking responsibility if anything happens.

Follow policies / procedures. Pay attention to details. Don't be afraid to ask questions. Pat yourself on the back when you make it through your first Massive Transfusion Protocol! Let the adrenaline work for you -- keep calm and work on. Enjoy Blood Bank -- I've been doing this for 30 years, and I love it!

We always work up a positive DAT with elution and antibody ID.

Thank you for posting this information. I just listened to the podcast and was thrilled to have another opportunity to learn something new and get CE at the same time. I plan to listen to other podcasts from the Blood Bank Guy.

We also use O Pos for males and females over 50. We use O Negs for all children up to about 20.