labguru

We do this to cover all of the bases in the event of a transfusion reaction. We keep an unopened segment and the segment that was used in the crossmatch. We keep everything related to the crossmatch for a period of ten days.

We do not do the testing in tube to confirm. We will send the sample to American Red Cross for Genotyping for RHD variants if the reaction is 1-2+. The majority come back as weak D type 1 and are not considered to be at risk for production of allo-anti-D. It is generally accepted that females of child-bearing potential with weak D type 1 can be considered D positive for transfusion and are not candidates for Rh immune globulin. Their type will be updated with that comment. If the patient comes back as one of the other weak D types and there is a chance for production of the allo-anti-D, we will leave it as Rh negative and put the comment that testing was done in the patient history.

Do you need to send notification to the FDA on these since the crossmatch will be positive?

What is everyone doing in TAR with a patient that is being transfused and then needs to be transferred to another facility? You may never know the actual stop time. Should the nurse put the stop time as when the patient left and approximate the volume of blood transfused or is that falsifying records? When I go in to look at these units it tells me that PCS is still in the process of entering transfusion data, which to me means the nurse is still on the transfusion in TAR, but will probably never look at it again since the patient has been transferred.

When we switched to the Ortho workstation, I asked CAP what to do about the temperature and this was there response: Taking daily temperatures on the Ortho workstation which contains an indicator light can be satisfied by having the techs record that the green light is lit and is "acceptable". Prior to allowing the techs perform this task, best practice would to verify initially that the temperature in the incubator is accurate against a certified NIST traceable thermometer. If you are unable to verify that prior to installation, that the temperature is accurate, then the manufacturer would need to provide to you that the internal temperature has been calibrated by the company. The process that other labs are doing that you described would also be acceptable. Thank you for your inquiry, Ljiljana Petkovic, MT(ASCP)SBB Laboratory Accreditation Program

We use Ortho Gel for the Blood Group, and tube for the weak D.

According to the limitations of the FMH screen, if you have a weak d (which we don't know if it is or isn't because of the positive DAT) you must use a test to detect feto-maternal hemorrhage other than the screen. You only know if it is a weak D if you do the weak D testing on an Rh Negative specimen and when you add the Anti-IGG it will show up in this patient as positive due to the DAT. I think the positive DAT was due to the ABO incompatibility. We perform a weak D on all our Rh negative cord bloods to determine if the mother needs RHIG.

Over 100 views and no comments? Is it safe to say I'm the only one with this issue?

CAP standard TRM.40130 is a new standard that deals with alternative control procedures. It states "If the laboratory performs test procedures for which control materials are not commercially available, there are written procedures for an alternative mechanism to detect immediate errors and monitor test system performance over time. The performance of alternative control procedures must be recorded." We use the Ortho Confidence system for gel. We also use AB Plasma (we aliquot one unit of expired FFP and use it until gone) for our reverse type in confidence cell 1, to test the buffer part of the card and also to test our screening cells in the IGG card to make sure they come up negative. If you use the Ortho system, do you test your buffer cards (or last 2 cells in the ABO RH Reverse card) and IGG cards in the same way? It sounds like this new standard applies to what we are doing, correct? We don't have a procedure, but we do monitor and review. We even do a 20 sample crossover before it is put in use.

Mother is O negative, baby is A negative. The DAT on the baby is positive, so the Weak D is inconclusive. According to the limitations of the FMH screen, if you have a weak d (which we don't know if it is or isn't because of the positive DAT) you must use a test to detect feto-maternal hemorrhage other than the screen. We send out a KB for this determination. However, the limitations also state that "in cases of ABO incompatibility between mother and child, the mother's natural ABO antibodies may destroy any fetal cells in the maternal blood specimen before testing is performed. This is true for any method of detecting fetal cells in the maternal blood." So my question is would you send this ABO incompatible specimen out for a KB or would you just issue the mother one vial of Rhogam and not worry about the KB since nothing may be detected? This was an uncomplicated vaginal delivery.

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So tube is your back up method?

We run the current positive and negative controls (before they expire) with the new lot of Indicator cells and D reagent. We are not comparing results, we are just making sure our new reagents are giving us a positive and negative result. This was under direction from a call to CAP. I guess it could depend on who you talk to there as to what answer you get though.

My Ortho rep informed me that for a patient with an antibody the immediate spin in a buffer card still needs to be done because the IGG card does not pick up the ABO incompatibility. So we have both crossmatches in our result field. We will put the immediate spin results in first, then we will replace the IS XM with the extended XM (AHG).

We have Meditech also, and once the doctor orders additional product, Meditech will attach it to a viable sample if there is one through a Daemon. If the current sample is due to expire shortly, it will order a new TS and XM which will need to be collected.

I was wondering how other labs handle a unit of PRBC that you have to antigen type before a cross match. We edit the unit in Meditech and put in the positive or negative result in for the antigen. We only have a worksheet though for our reaction data. Is that worksheet something that needs to be kept for 10 years per CAP (Donor Blood Testing) or since we changed the unit and it is saved in our LIS we are ok not to save the paper worksheet?

That is the direction I was thinking of going, but as you said, there are a few that will protest because of their level of paranoia. I'm not saying that it's a bad thing. Thank you for your input!

Is there a requirement to have a secondary or back up method to your primary method? We use gel for type and screen and ab id. We have the reagents for the tube method for these, but rarely ever use them. I've been in the Blood Bank for almost a year so I'm a newb and the one time I used them I ended up sending the sample to a reference lab anyway.

Can someone help me out with the term "child bearing potential"? I am revising a "Emergency Release of Blood Product" procedure and it states that a Female of child bearing age should get O negative blood. Of course this is a patient with unknown ABORH and in an immediate need of transfusion. My thought is any female under 50 years old should fall under this category. Do you have a policy that states a specific age "range" for these females? Is there going to be a difference in a 6 year old and a 12 year old in terms of creating an anti-D? I guess I'm getting hung up on the term "child bearing potential" and I don't want to think of a child as having child bearing potential- but I guess they have the potential until they hit menopause. Or do I have this wrong?

I'm looking into the platelet agitator/incubator. Does anyone have any thoughts on this?

What would legally need to be done on our end to satisfy the governing bodies? Are you allowed to give out blood without all the policies being followed. With no ability to get a blood bank tube or anything?

A victim fell off a cliff and was mangled on rocks below. Medflight and EMT squad arrive on scene. Medflight will not take victim because there is no pulse. EMT take victim and perform CPR while enroute to hospital and they get a pulse. Hospital is notified that patient will be picked up at helipad (since there is a pulse) to fly him to a bigger hospital with Level 1 trauma and have 2 units of O neg waiting. My question is: Has anyone ever been presented with something like this? The victim was never admitted to hospital, no name, no info. According to Physician on Medflight there was mass amounts of internal bleeding and they needed the blood as a life saving measure and the victim wouldn't make it to the next hospital without it. What would you do in this case? Or what should be done?

Nice, so both results are visible.

Why would you cancel the Immediate Spin, since it is looking at the ABO compatibility and the Extended Spin is looking at the Antibody compatibility? Don't you still need the Immediate Spin since the are looking at two totally different things?

We use Ortho gel and the insert states that, "...there is an FDA requirement that the specimen should not be stored for longer than 3 days before testing. AABB Standards impose more lenient storage limits." How do you get around this when it comes to Inspections? I want to change our storage times also, but feel like my hands are tied because of what the package insert states. Does anyone have some advice on what to do? The problem I have is Pre-OP testing is done a week or so before, the patient has an antibody that I have to send out to identify. Now the patient has a surgery scheduled on the following Monday....I have to get a new sample to the Reference Lab on the Friday before surgery because it is an extra charge for us if they come in on the weekend. Now when the patient comes in on Monday, that is the only day I can use this cross match because of the 3 day limit. If she needs blood post surgery we have to draw again and send to the reference lab again. Its like an endless cycle that seems so wasteful in time, money and resources. Any suggestions here would be great!