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No I would use PEG for tube testing and Albumin for certain situations. We dropped NHANCE several years ago

"It's time to phase out “serologic weak D phenotype” and resolve D types with RHD genotyping including weak D type 4. " I realize I'm a little late to the thread but thought I would share our practices at our US facility. newborns are only tested for partial D when they are initially Rh Negative. We use capture method and the ECHO does a fine job picking up weaker expressions of D at the RT phase of testing. I recently sent our 1st maternity sample out for molecular typing and plan to incorporate mandatory molecular as a reflex test in the future when the anti-D test result is 2+ or weaker. The 1st sample came back as an RH type 3 and as such would not be eligible for RhIG by the new recommendations. always interesting to see what other facilities do for their maternal testing and I appreciate all the insight on the forum

we have used Verax for almost two years and are looking at conversion to day 4 and day 5 by the end of the year. Since we are in a non-metro area we do not produce a surplus locally and must import Apheresis platelets to meet our demand. Our suppliers (ABC) do not plan to universally switch to PR-Apheresis and since it will also decrease product availability and impact local accounts in a negative fashion. I don't think the other supplier will be able to meet the current demand for apheresis platelets with a PR-Apheresis as they struggle to meet demand already with NON-PR products COVID has really put a damper on our local donations and will continue to do so for the short term

we use Awarepoint sensors and they continually monitor the temperature and can send hourly updates and temperature alerts. this is an expensive solution that our facility is going to replace with another vendor. I would recommend the data logger also or a thermometer with an attached liquid sensor. See example - the sensor can be relocated into a larger vial of glycol to assess the temperature characteristics of the cooler and any bags or containers stored inside. This would require looking at the cooler every hour or so to verify temps or use the High/low tracking to gauge the storage temperature. CARDINAL HEALTH Previously Purchased Contract # LCNDP/9000420601 Compare Cardinal Health™ Jumbo Triple Display Large Digit Alarm Digital Freezer Refrigerator Thermometer, -50 To 70DEGC Material #: CH2960-5 Manufacturer #: ACC895RF Available EA $32.05EA $32.05 QTY Available

I just answered this question. My Score PASS

If you have willing staff in your pre-surgical unit what we do is have them pull a second sample when performing the I.V. start as they are pulling a syringe in most instances anyway to get I-stat results for anesthesia. Food for thought. We do not retype type O individuals and we also do not require the redraw for ER unless we are already redrawing the individual. ER patients are issued O pos or O neg depending on gender/age. Barr - Blood Bank Coordinator

I am in agreement with John here, we routine use both the 3mL and 7mL tubes for transfusion testing. I have been using the Immucor Echo for two years now and manual gel testing prior to that. We have been utilizing the two tube types for the last nine years with no discernable difference.

Yes, there is a requirement through JCAHO and our facility must perform at a minimum of 50 audits per month to satisfy the regulatory requirement. If you transfuse over 500 units a month this requirement is a minimum of 100 audits. Our risk manager has confirmed this information and I do monthly reporting through our corporate RM software. Are you doing 100% audits right now?

As a transfusion service we notify all potential recipients with exposure to Hepatitis B , Hep. C, and HIV. Even if they receive no follow-up testing for viral markers their physician has implicit knowledge of the risks the patient has going forward. I for one would want to be notified if there were a potential problem regarding transmissable viruses. Look backs have decidely declined since the advent of the HCV and HIV PCR testing. I have only had one lookback in nine years for a Hepatitis B donor (HBsAg+) whose products were transfused at our facility. Good luck with the Medical director

How many Fetal screens do you have that are positive annually? We only have a handful each year and our L&D dept. delivers about 40-50 newborns month. Our reflex method on positive fetal screens is Flow cytometry for Hemoglobin F and it is performed by our reference lab. They are located 1 1/2 hours from us and even on weekends we have next day reporting. Also, Pharmacy dispenses our Rh-IG to Labor and Delivery.

I would recommend not utilizing a tube procedure, in our experience we have had difficulty supporting the infusion set for more than twenty tubes. In the past when we have collected tubes it typically requires two to four venipunctures to complete the order. The needle typically gets obstructed by clot and it is not possible to strip tubing on the winged infusion set. I would support using the syringe method as this will not collapse smaller veins to the same extent as tube draws. Good luck, Barr

We also use Jewett for our undercounter model. It has been great unit and model BBR6 comes with one drawer and the temperature/alarm monitor.

I agree with you regarding the reference labs, all this did was confuse the ordering physician by having 2 different titer results on the most recent sample. For the anti-M there has not been a tube change in the titer it remains 1:8 from the initial sample. The reference lab is still doing tube method for most testing and is using Quotient BD for their reagent supplier. In the future I will only report the anti-M IgG titer as this is the relevant result for the physician. I questioned the initial order from the physician as there has been little in my career to indicate the anti-M would be problematic in regard to HDN. Now an anti-Kell or anti-E by all means I would pursue the titer to assess the risk for HDN. Thanks for the wonderful answers TX Blood Banker

we use the labels from Veriad and document on the sticker the testing result. The label is placed on the unit by person who tested for the antigen and the results are also recorded in our LIS software. This includes only antigen-negative blood that is documented in the LIS, all antigen results are recorded on our daily testing log and are reviewed by myself or my counterpart for accuracy and completeness. I have a question regarding process, if you do not use the blood that has been tested do you remove the label when issuing for a patient with no antibody? There are always inquisitive nurses that question the presence of the antigen label, normally I do no remove them upon reissue.

I have an example of an anti-M that is being monitored in a maternal patient for antibody titration. Since there is a collective wealth of knowledge here I figured there would be somebody with an answer. The father is an M-positive individual and the patient has had three titers performed now, the first in October was anti-M reactive at AHG - titer of 1:8, the second titer was 1:1 - AHG, the titer performed this month was again 1:8 at AHG but had an IgM component reactive at room temperature at a 1:2 titer. My question pertains to the significance of the titer results, is the mother considered a high risk pregnancy now that both antibody types are present in her sample? Also, what woud be considered a significant rise in titer in this patient, In my limited knowledge I have the understanding that the titer should have doubled to be considered significant, is this correct in relation to anti-M? Many thanks

WE DO NOT require a 2nd draw on Labor and Delivery patients and similar to your situation the intial pre-natal testing is done by a reference lab not affiliated with our hospital. However, in those instances where we have no blood type history in our LIS I ask technical staff to obtain history from the patient's chart, the reference lab report is bundled with their admission documents upon arrival. I see no issue unless the mother needs a C-section and a type and screen or crossmatch is necessary.

Sounds like it would be better to purchase new equipment every time something needs moving! I am getting ready to move equipment in our Transfusion service about eight miles to a new location. We have our Biomedical department re-certify the RPM and timer checks and I will perform serofuge concentration QC and cellwasher QC. I see no reason to perform temperature re-mapping on storage units. If the Blood Bank refrigerator is not able to maintain temp. then It will be taken out of use. It sounds as if the regulatory burden in the UK is more stringent in regards to equipment and process control. I extend my sympathies.

In my limited experience with FDA inspections, one in eight years, they are quite meticulous in inspecting logs and procedures. My inspection was unannounced and we are a non-licensed transfusion service. Day one I was off work and my counterpart in Blood Bank gave the inspector all the manuals and insight needed, Day 2 I was present and walked her through our SOP's and documentation. She did not have any background in laboratory and seemed confused by the simple things that we were doing as a transfusion service. She was somewhat rude but overall did a good job, we were written a recommendation on correction of clerical errors. One of my tech's was fond of white-out and was making corrections in our disposition log with it.

The PEG was just an oversight ( I have never used or seen solid phase in a demo), so upon receipt and install of the second ECHO will you do away wih the tube testing reagents and methodologies since you will have an onsite backup? Also, did you have to wait for budget approval in a fiscal year outside of the initial purchaseof the first ECHO or was it all bundled into one purchase for the same fiscal year? We are looking at purchasing only one unit and keeping the tube testing as the fail-safe backup for our future methods.

We typically administer ten units of cryo, but in those circumstances with extended surgical times we typically give a dose of twenty units (especially to CABG/AVR patients).

It is extremely difficult to obtain CPDA-1 blood units in our region as our local blood center does not collect these units and neither does their secondary supplier of blood. Also, it seems to me if you are worried about the presence of anti-A and anti-B in the units than you should remove the additional plasma by expressing the unit after centrifugation (shortens the lifespan of the blood). Another alternative is to split the unit into Pedi-paks, then centrifuge, then express plasma/additive, and add back type AB pedi-plasma to maitain a HCT of 70-80%.

If you are using gel there is very little need to pre-warm in the hospital blood bank. I recommend to our staff that pre-warm be done only in instances where we have demonstrated the presence of a cold auto-antibody AND no alloantibody is detectable using a PEG panel in the tube procedure. We also do a gel panel using the Ortho A panel to initially identify those antibodies that are not of IgM/complement specificity.