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Hi All, I have a question, but firstly good old story time for some context. I came across a patient who had positive antibody screen on all three screening cells used (BioRad). I was concerned this may be an auto and pan-reactive, and required units. Performed a monospecific DAT, showing a positive reaction to IgG only. By this time antibody panel finished cooking and showed the patient may have anti-Fya , but couldn't do phenotype. By this time I was nearing my shift so handed it over to my colleague and asked for some units to be crossmatched. However, he refused as DAT was positive and said he rather send the sample to reference laboratory for them to crossmatch. The next day I crossmatched units to verify if it could have been done in our laboratory (just because I am sad that way), and turn out the unit I crossmatched was compatible (which I wasn't surprised about) Question Why does positive DAT (or the cause of positive DAT) sometimes interfere with IAT techniques (such as antibody panel and crossmatch) and sometimes it does not? If both use AHG, then wouldn't positive DAT with IgG cause antibody panels shows pan-reactive with red cells? But obviously it doesn't, but I'm trying to figure out why, and I'm sure the answer is quite obvious. My laboratory seems very hesitant whenever they see anything regarding autoantibodies or positive DAT, and thinks that sample cannot be crossmatched in-house and needs to be sent off without even trying to investigate. Hopefully, by me asking this question, I can explain it back to my colleagues (but obviously take all the credit). Cheers in advance, Jermin

Question: Do you bill for all crossmatches performed? Or only the ones that were ordered? Example: 1 RBC is ordered. Patient has a an antibody. You grab 4 units and crossmatch through Coombs. You then antigen type the compatible units. Do you bill for four XMs? Or just one? What about antigen typing? Four units? Or just one? We used to bill for all work done. Then someone told my director that we could only bill for what was ordered or it was medicare fraud.... but, I feel like that is not applicable to patients with antibodies that require much more work to find compatible blood. Thanks, Morgan

Looking for others in smaller hospital settings encountering DARA patients in blood bank; we plan to send affected antibody screens and crossmatches to our blood center's reference lab for workup and have them send us crossmatched units. Currently we do not plan to add DTT to our in-house testing, just rely on the reference lab due to the size of our blood bank. Curious if this is working for others. In event of emergency, do you release uncrossmatched? try to do IS XM? Would like to know what others are doing and how it's working. Thanks in advance!

It's been years since I've done test tube blood banking and even then I didn't have to do any sort of daily qc. I'm bringing back the option of running a test tube IS xm to speed up add on units and I don't know if there's any sort of QC required for this. It's patient vs donor. Is there anything to QC daily? Thanks, darren

Question: How do you proceed when a provider is adding units on a specimen from a different date (<3 days) in your LIS (I use Meditech)? I am a little confused about this issue, some techs at our lab add on units to the original specimen, others redo a TS and crossmatch on new order... specially if it is a different provider who ordered the crossmatch vs TS. And is there any CMS or other billing reg about this situation? Thank you all in advance for your help! Helen

Our current procedures for blood type (and anything including that) state that we need to do a patient re-type if there is no blood type history on the patient. We will just do a forward type on the current specimen. We are going to be setting up electronic crossmatch (soon, I hope) and will be required to test a specimen collected at a separate time for the re-type. I am seeking input on how you folks handle your patient re-types. We are also currently doing the re-type on every specimen -- including cord workups. We know that when we start the electronic crossmatches, we will not be getting a separate specimen on those babies for the retype. What do you do for traumas, pre-ops who come in a few days before surgery and only blood bank ordered, etc. Because we have been testing the same specimen for our retype, it adds on to that original requisition. I will have to change the retype to make a new requisition. Any suggestions will be appreciated.

Greetings, How long do you hold red cell units in a crossmatched status? For the life of the specimen? For 24 hours? Also, do you crossmatch the same unit on multiple patients? Thanks!

What is your facility's procedure for crossmatching patients with a history of anti-Bg? For example, do you use gel crossmatch or another method? Our location doesn't have antisera for antigen typing.

We are in the process of updating our crossmatch procedure. I am wondering what the policies are at other Blood Banks if an Anti-M reacting at AHG is detected. Do you give extended crossmatch compatible or antigen negative? Also, what is the procedure if the Anti-M only reacts at immediate spin? We appreciate the info, thank you!

Is anyone out there currently using Cerner Millennium for electronic crossmatch? I would mostly like to know how and when the unit is assigned via electronic crossmatch. Does the computer automatically assign the unit, or is the unit to be electronically crossmatched scanned in to be assigned? Is the unit assigned in Result Entry for Blood Bank, or is it assigned when dispensing the unit? Any help to these questions would greatly appreciated?

I am researching a buying guide for laboratory managers looking to update the analyzers in their transfusion laboratories. I am interested to know what you are using for crossmatching and 'group and types/screens'. Feedback I have had so far is that there are a lot of Immucor Echo/Neo's and Ortho ProVues in use. Is anyone using anything else and what do you wish you had known before you purchased it?