jshepherd

Not sure I can help your argument, as we give O pos immediately to all males and females over 50, for any amount of emergency products. If you're wanting to argue for O negs as the first products when the blood type is unknown, it may not be received well, as this is very much becoming no longer the norm across the country, as far as I know.

Yes, when there isn't a true massive, it is more likely the patient may make an antibody. That said, we have the same procedure here as you Kym: we give O pos to males and women over childbearing age for ANY emergent release red cells. If they only get 1 or 2 units, then so be it. This is part of the battle of using inventory appropriately and calling a code/massive appropriately....and never the twain shall meet.....

Technically, any sample you don't know the answer to is "blind" to you, so any regular patient with no history can be used for a blind blood type for example. Yes, for DAT and FMH it's harder, but we typically use the CAP samples as Bet'naSBB said, rather than try to make up samples that are not quite right.

Exactly what Malcolm and Dr. Blumberg said - we've been doing this (in the states) for more than 10 years at my facility, rarely do we see an Rh neg trauma patient, and even rarer do they make an antibody to D if they survive, which for us is a significant percentage of trauma patients we see (98% survival rate). The key is giving the mismatch during a massive bleed, not just a onesie twosie transfusion. This is also why we give type A plasma to unknown type trauma patients, instead of AB.

Same, I worked at one facility that would stuff the shelves, and my current department doesn't have a need to, so we don't. I don't recall any guidelines/standards on this, but if they are overstocked it could be a waste of money.....

We have Helmer fridges/freezers, that will still alarm locally and audibly if the built in temp probes detect something out of range. We also have the Primex temperature monitoring system, and there is one probe per fridge (even the double wides) that resides in the same glycerol bottle as the top temp probe. To my knowledge, the bottom temp probe on the larger fridges is not one that drives alarms, but will alert to being out of range. Inspectors have never questioned this process......

The 5 or 7 day shelf life of PR or LVDS platelets depends on the timing and method of how the bacterial sampling is being done. There were several options laid out by the FDA when the whole LVDS thing was implemented, and ARC chose to go with the 36 hour LVDS process, which did not allow for a 7 day platelet expiration, but only a 5 day. Other blood suppliers chose to perform LVDS at 48 hours, which will give you a 7 day expiration. It is an ARC problem. Verax is not FDA approved for PR platelets, so you can't use it to extend the expiration. We were doing Verax on our normal PAS platelets before the LVDS rule went into effect, and had to stop once ARC switched over to all PR. We recently brought in cold stored platelets from ARC. FDA says these are best for bleeding patients, but won't allow transfusion services to maintain a dual inventory and preferentially select CSPs over RT platelets based on the patient need. They say if all you have is CSPs, then they can be given to anyone who needs platelets. ARC supplies us from Omaha and St. Paul, and I am in Denver, so getting RT platelets here is feasible, and has been fine, but it's not practical as we have to get a shipment daily to maintain our inventory and keep platelets in house for trauma (Level 1 adult, level 2 peds center). We decreased our standing order of RT platelets to get CSPs in house, and we use the CSPs only when we are out of RT platelets - as the FDA has said is approved, but also to reduce the amount of platelets we are tossing due to short expiration.

We ended up making our own solution, similar to Cliff's post. We created a program that allowed us to use a normal scanner to create a file in our shared network drive. Each patient has one folder, and within the folder are the different antibody workups, labeled by date of workup. It was a manual process to scan them all in, but one of my techs completed it in her downtime in about 2 months. It's only 1100 patients, but many have multiple workups per file. The shared network drive is backed up routinely, and we were told would be one of the earlier things to be granted offline access in an extended downtime. I am now impatiently awaiting the day I feel comfortable to get rid of all the paper that has been scanned in.....and then figure out what to do with that giant file cabinet.

Hello! I've worked with Immucor over my entire 18 years in the BB - you should be able to reach out to your account rep for the info you are seeking regarding ABID troubleshooting. They have a collection of white papers that can help you. Regarding your Rh negative confirmation in tube - that sounds like something specific to your facility. It's not an Immucor recommendation that I am aware of, nor do we do that at my facility. The CMT plates are literally just a blank microtiter well, so the reactions are very similar to tube, and are read the same way. The trouble with the instrument reading the reactions is that it will not detect mixed field or rouleaux and can have false positives because of that.

We have a Temp Check device. Temp-Check Rapid Response Thermometer For Healthcare| Digi-Trax® This is what we use to take temps of all products being returned to us.

I hate those things..... in my experience, they are not very accurate and are so temperamental. We had the BT10 on all our units that went to the ED fridge a few years ago, hoping it would help us provide return privileges for those units. They too started activating on their own having never been moved from the fridge. Must you have the temp indicators? We have a TempCheck device we use here in the bank. People returning products must get them back to us ASAP (no time limit) and we take the temp with that to determine return capability. It's pretty good and has proven accurate to our reference thermometer for years. Plus, it's a one time purchase. I've heard of people using infrared temp guns as well, but I've also heard those can be temperamental because of the air temp the infrared beam has to pass through to get to the unit itself.....sounds too complicated.

Sorry Malcolm! Agreed, our policy is that all females are of childbearing age until they are 50 years old, so we would give RhIg when indicated for an 11 year old. But thank you for clarifying that excellent point!

RhIg after giving 12 Rh pos units is futile. The patient will either make anti-D or not, too late to prevent at this point without exchange transfusion, which seems like overkill. We always say the female of childbearing age has to live in order to worry about anti-D in a future pregnancy, so we worry about that first. Our policy is to revert to the patient's actual type after a massive situation. We would give A neg. Now, if the patient starts massively bleeding again, we would revert to A pos. Until the patient makes that anti-D of course. Even though you've already given Rh pos to this patient, you did it during a mass transfusion, which is physiologically different than tranfusing an Rh pos unit low and slow.

Sounds to me like you should only be concerned with the fact that you might be needing 2 exchange transfusions and a bleeding mom to occur at the same time. Busy, but not unmanageable. Maybe make sure you have blood and plasma per your SOP for the exchange in house, and plenty of A pos for mom. Good luck!

Has anyone found software that can help them digitize all the paperwork (antigrams, instrument printouts, etc) for patient antibodies? I have a HUGE file cabinet full of these things, and we'd like to make it electronic, but of course it has to be searchable by name and/or MRN and we would need access to it during downtimes. I'm thinking a third party software out there must have this capability by now....it is 2024 after all! We have Softbank and Epic, and I'm aware that Soft has this capability, but it will cost us upwards of $20K to complete the project, and no one has that just laying around these days.

Just a few nuggets I left in BOLD above. We use solid phase here, and back up to tube (we have PEG and LISS). I personally prefer solid phase, but each method has it's pros and cons. This is why you need more than one method to utilize. Good luck!

If the reactivity is only in the IS phase, and all other IgG phases are clear, you should do the things to resolve IS interference. If you can identify or think there is a cold antibody, then prewarm would be your answer. You can also wash the donor cell suspension to ensure there isn't something funny with the patient's plasma and the unit anticoagulant or solution.

Agree with Dr. Blumberg. If platelets are returned in an RBC cooler "on ice", we take a temp of the unit. If out of 20-24C range, we check for swirling, and if still swirling we will ask pathology if we can keep it, based on our current platelet inventory and the temp we got. Always up to them, but in general if it's only out of range by a degree or two, we'll accept it back. The coolers we use for RBCs are only out for 4 hours max, so these units are never in there very long, and they often come back within temp range (like they tossed the unit in the cooler right before bringing back the cooler).

Agree with Dr. Blumberg. The FDA guidance for CSPs states they can be used when "regular platelets are not available or not practical". This sounds like a more prophylactic use of platelets, which is also not practical. If you didn't have anything but CSPs on the shelf, and there is a request to transfuse, I guess it would be up to you as to how much you want to argue with cardiac surgeons for the sake of your inventory, given that these patients are not actively bleeding.

Agreed, sounds like you're moving to a less secure option for whatever reasons, so in that case I say go low tech and put a physical lock on the fridge door. Helmer sells fridges that have built in electronic access control, but you can also drill right through the handle bit and get a combo lock put on it. No access unless they call BB for the combo..... there are definitely ways to secure this low cost, I've got experience with both of these options and they work just fine after the surgeons stop complaining about it.

Level 1 adult, level 2 peds we keep LTO+WB for traumas - we give 4u per patient that has MTP activated, then switch back to component therapy.

The response I got from ARC is that it is up to our medical director. There is no FDA exception needed, as the FDA doesn't have a regulation on shipping duration or transit time. They only care about temp, and since the temps are in range, there is nothing to seek a variance from. I heard from people who use other blood suppliers, and the general consensus is that if the packing is correct, ice is still present and the units are in temp range, they are acceptable, as long as there is documentation of this deviation from the hospital's normal policy. I ended up adding this tidbit to my SOP as an allowed deviation by our medical director, just need to fill out the deviation documentation form and have him sign, but this way, we can accept the units in immediately and not delay having them be available. Especially important for platelets!

Our blood is shipped to us from Omaha and St. Paul (ARC), and sometimes arrives to Denver later than the transport boxes are validated for, which is 48 hours. These units are frequently still in the acceptable transport temp range, be they platelet or red cells. Historically, we have tossed these units since they did not arrive to us within the validated time frame, but I am looking for a way to stop doing that. The FDA publishes exceptions to 21CFR640, which are publicly available, and has many exceptions listed where they have allowed the use and distribution of products when they were stored outside of the required temperature ranges for a specified amount of time, ranging from a few minutes to several hours. I cannot find in any FDA regulations where I would be allowed to accept the products in the situation described above, when units are in temp, but over the validated time frame of the transport container. Has anyone encountered this before, and what do you do about it? Is this simply a decision for the Medical Director of my hospital, or does this require an FDA exception?

Exactly!! The answer is because the FDA says we have to..... I have never seen a mistyped unit from any blood supplier in 17 years. ABO or ag typing.

We do not recheck ag typing. One and done. If our supplier sends us antigen neg units, they are either typed in the moment by the supplier or labeled as "historically negative" which means the donor has been typed twice by the supplier and will not be typed again. As @NicolePCanada said, you're still going to do the AHG XM, so no need to cause undue stress. Also agree fervently with @exlimey that you should not make something like this optional.