TreeMoss

Yes, we want actual products -- so we can thaw the FFP and Cryo to see when they would actually be ready for use.

We are going to begin running Mock Massive Transfusion Protocols in our facility. We need to "manufacture" some blood products to use in these drills. Do any of you have "recipes" for making up packed cells, FFP, Platelets, and Cryo products to use for practice? Thank you

This is what we do to crosscheck the fetal bleed kit, also. The fetal stain (Kleihauer-Betke) just requires pos and neg control slides. We made a change a few years ago after COM.30450 came out -- when I read it, I didn't do anything because I didn't think it dealt with blood bank. Our inspector had other ideas! Change was then made, and we have been crosschecking all reagents on arrival in the lab against those reagents already in use. When I did a recent CAP inspection, the lab argued that this item states "suitable reference material" may be used -- and that would be a positive and a negative control. I called CAP to clarify and was told that checking new lots of reagents with a positive and a negative control is all that is needed. Yes, I'm going to revise my procedures back to how they use to be! I should have challenged that deficiency from a few years ago -- but live and learn. We do, however, check our new screening and panel cells with the old screening and panel cells when the new sets are received.

I had the same thought. If you don't modify products, you don't need to have the FDA registration -- and you don't need the privilege of having them come to inspect.

You need to follow manufacturer's recommendations, so review the user's manual and see what they require. Ours says that we must do an inspection of the weld at least once a day, so I built a log sheet to record patient name, unit number, wafer cartridge lot number, bag/syringe lot number, weld inspection, weld alignment, corrective action, and tech initials.

We give antigen-matched units when the patient is on Darzelex so they hopefully wouldn't build any antibodies. Would you continue that when the screen was once again negative, or would you just select any compatible unit?

We did the same, sharing the information about the availability of AB FFP and how the majority of patients are A or O. They agreed that we could make that change.

We have pre-determined Doe names -- we go down the phonetic alphabet with a different number as the "middle" name each time through the list, i.e., Doe, Alpha 35; Doe, Bravo 35; etc. As a level II trauma center, we have 2 levels of traumas -- full and partial. We usually have a name with the partial traumas, but the full traumas are assigned the Doe names and are given a new Medical Record #. The admissions dept. quickly registers the patient when word arrives that the patient is coming in. We use the Mobilab system, so the armband label is placed on the patient and labels made by scanning the armband are placed on the specimens -- so we have the two identifiers that are needed. When the real patient ID is made, admissions puts in the name but leaves the Doe name in parantheses on the armband and other patient ID. The new MR# given stays with the patient at least as long as that initial blood bank specimen is valid (72+ hours to midnight). At that time, if there was a pre-existing MR# for the patient, the accounts are merged. When uncrossmatched units are issued, we place them in a cooler and write the unit information on a cooler log sheet. Since this is an extension of our blood storage refrigerator, the nurses sign the unit out of the cooler using the log sheet. We have patient ID information on the log sheet, but we do not go over all of the unit information at the time the cooler is issued. We use Meditech in our facility, and Barcode-enabled Transfusion Administration (BCTA) is used -- so one nurse can check the unit with the patient when using the computer for the other nurse. We also use Electronic Crossmatch that makes our lives much easier. This system works very well for us.

The book has the answers included. Per the preface of the 2013 manual, "a digital version of the questions without the answers, to better simulate a serologist's progress in solving these problems, is available for purchasers of the printed volume." Access to the file is by a link listed.

I would suspect so -- if agglutination is happening at lower temperatures in a test tube, I would expect the agglutination to be occurring in the cooled down patient.

So excited that you are being recognized for your contributions to our field. This is well-deserved.

I'm sure that would only be in cases where the patient was cooled down. I'm sure there have been times when a blood warmer was used in surgery just as it can be on the floors.

They usually are, so I'm sure that is the case in heart surgeries, as well.

The physicians would use cold cardioplegic solution -- 4 degrees - when putting the patient on bypass.

We simply used a beaker with water and ice and maintained the temperature during the 15 minute incubation period. This procedure was brought to us by a perfusionist who had been an MLS prior to becoming a perfusionist. She developed these procedures as part of a project when she was in perfusionist school.

We used to use that same procedure when we were doing open heart surgeries and the patient was on bypass. If our antibody screen was positive at 4 degrees, we would test at 10, 15, and 20 degrees - maybe even 30 degrees if the room temperature incubation was positive. Whatever the thermal range was, we would then do an antibody ID (who cares) and titer at that temperature. We would also include a test at 4 degrees using a 20% suspension of the patient cells to see if there was agglutination after 30 minutes. We in the blood bank were very happy when new surgeons were brought in who no longer wanted that testing -- working on beating hearts and doing mini valve replacements, etc. has helped us immensely.

We do the same. We also offer to do a blood type at no charge if the parent(s) want to bring the baby in to the lab in 6 months or so in order to get an accurate blood type.

I have attached the screen shots of the set up of the Order Group and Test in Meditech. Type Reflex.docx

We use MobiLab and do not have a separate Blood Bank wristband. We love MobiLab! We are able to use hematology specimens if they are labeled with a patient wristband label at the time of collection. Our specimens are collected by phlebs, ER folks, and L&D nurses. If the patient ID band is removed and not immediately replaced in a different location, we require a new specimen to be collected and tested. We also have Temporary ID bands (TID) from Biologics that we use in times of computer downtime.

We actually have two history questions on the result screen. The original Type History question is the one that a "No" reflexes the re-type specimen. There is also a "Previous History Check" that was added when we went up on BCTA (Bar-code Transfusion Administration). The We have four possible answers for the previous history check question -- No history, Yes hemolytic reaction, Yes non-hemolytic reaction, and Yes no reaction. There is no reflex order from this question.

We do perform in parallel if we have a previous specimen from the same pregnancy.

We have a "History" (Y or N) question on our result screen. If there is no history, a patient retype (forward type only) reflex orders on a new requisition, so the specimen can be collected. You just need to set it up like any other reflex order. Our L&D nurses draw most of the specimens from their patients. They also draw the extra tube for our retypes, but we often wonder when the labels are printed just 1-2 minutes apart. Everyone we ask verifies that the specimens were collected at separate times. I see that we're not the only ones with that concern.

We accept specimens drawn at the oncologists' office and labeled with Temporary ID band labels with the TID band placed on the patient's limb. Otherwise, all patient specimens are collected at our facility with the armband being placed on the patient at the time of specimen collection.

We follow the AABB guideline and test only in tube method.

We also have empty blood bags returned to the blood bank. We keep them for 7 days following transfusion. We keep the bags in the morgue where there is room for storage. We decided this was the easiest way to keep what we needed in case of delayed reactions, especially since we don't have many of these called. We thought this was easier than having to pull segments off of the units and store. We have a special door below the Blood Bank window where the nurses or volunteer can drop of the units into a biohazard bag. We just fill up the bag, label with in and out dates, and take to the morgue. Pretty painless!