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)
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,
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.
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?
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!