Cold panels. Pre-warm panels.

[evilwarning]

I just started working as a generalist at a hospital. My first stop is blood bank and I'm already nervous. The SOP is old and difficult to.follow. I have very little experience with antibody panels.

When does one do a cold panel? How about a pre-warm? Ppl at work say no one knows how to properly use these techniques. What if I have a cold auto?? How do I work that up? How about working up a warm auto? I'm so lost! Please help!!

[Malcolm Needs ☆]

Please could you tell us what techniques are available to you; tube, column agglutination, solid-phase, etc?  Thanks.

[galvania]

And where are you?

Anna

[evilwarning]

Lol.

Just tube method. Echo only does screens. I live in west Texas.

[Karrieb61]

My first concern here is- who's overseeing your training? This sounds pretty scary to me if you are being left on your own to figure out old SOPs. Is there no Blood Bank Supervisor? Did they ever put together a flowchart about what to do when you get what looks like a cold auto or allo from your screening? Do you have a Lab Director to talk to and ask who should have answers for these questions. I do understand that many blood banks are not overseen by blood bank experts but that's no excuse for leaving a tech helpless. Are you accredited by CAP or AABB? Why are only screens done on the Echo? That sounds weird too. Bottom line is that someone needs to be held accountable for the validity of your SOPS but if people are saying they don't understand them, then I would get the heck out of there unless you find someone to help you.

 

I was out of BB for many years when I landed back in one and have re-learned  A LOT right on this site. So my first suggestion is to look at the tons of previous posts here on how people handle colds and whether or not they do prewarming. You will see many opinions but they pretty much fall into a pattern. Overall, the consensus is to avoid prewarming since a traditional screen will use 37 degrees incubation which should take care of most colds. Otherwise, you risk warming-away a significant antibody.

Colds I have a problem with myself. Unless they are Anti M's which may carry through to IgG/Coombs testing at the end of a screen or xmatch, colds are generally harmless. Your unique patients may  be those who require a blood warmer but those are few and far between. One problem with colds we have here (which I am trying to address around other stuff) is that we do cold screens and panels in the 4 degree frig which the reagent manufacturers don't approve of. So what happens if there is an adverse event with the patient and the FDA says show me how you were able to validate a procedure not approved by the vendor?

 

Hopefully lots of the GREAT folks here will respond to you also but my experience as a consultant working with 19th century labs is that I've seen these situations before and you are smart to be worried!!

[SMILLER]

I happen to think cold work-ups are usually a waste of time.  If an unexpected antibody reacts at 37 or IgG, that's another matter.

 

But for that situation's protocol and the procedures that would go along with it (and for warm-autos or whatever), we have a detailed policy and procedure manual.  And where a lab may be able to get away with the bare minimum for P&Ps in Micro or Histo, your lab absolutely MUST have everything spelled out for you on BB.  AND you must have comprehensive training in every area you work in before being set loose by yourself on patients. 

 

So I am more concerned with that, just like Karrie is above. I would say check with your manager on training and P&Ps.  It sounds like an odd situation to me.

 

Scott

[tbostock]

Yes, lots to be concerned about here. You should not have to try to figure out Blood Bank on your own.

[Mabel Adams]

I agree with the other posters above about the apparent lack of training and procedure support.  They have said the important things in that realm so I will veer off a bit.  

 

I learned most of what I knew after my first 15 years of lab work because I called the reference lab with every problem case and asked questions or I read the Technical Manual and other references.  After that I got into online discussion boards like this and started reading Transfusion to further my education.  All of these can be valuable resources for you.