JJSPLAYHOUSE

We're in Georgia and our Chemistry departments had to borrow from each other for months due to the back order issues. 

@exlimeyI agree, but with the overuse of O negs and the continuous donor shortages, O pos have become the standard emergency unit for anyone not female within childbearing age.

This may or may not help.
Clinical Aspects of Transfusion Reactions.pptx

Agree! Save the life first.
Our medical director would likely order at least one DAT the next day, possibly for additional days, to monitor. Anti-E is generally relative benign (though I have seen one patient who had an acute hemolytic reaction), We might also monitor plasma Hgb or haptoglobin, depending on the antibody involved.

You did everything that was required in this situation. The patient was a trauma and needed emergency transfusion. The risk of death outweighed the risk of a hemolytic transfusion reaction in that scenario, according to the treating physician. I once had a trauma surgeon tell me "I can treat a transfusion reaction but I can't treat death!" That put things in perspective for me. That is why thy sign the consent.
Next step would be to report this to your risk management department so that follow-up can be made, including monitoring the patient for the s/s of DTR. 

We have a statement on the order in Epic that they click.  It's a slightly abridged version of the 
AABB regulation.  I don't think the signature ever made them think twice where I have worked.  They didn't usually sign it until after the fact anyway.  We still have the paper version if needed but seldom do.

While I understand the convenience of making MTPs and emergency release a paperless process. I regard the physical signature a good reminder that issuing uncrossmatched blood must not be taken lightly. 

We only use Hematrax just in the event that our LIS is down and unavailable. You have no LIS for your lab? So your lab results are handwritten? I can give you instructions on how to use it but I would need time to dig them up. I will if you still need help. Good luck. 

Attached is my procedures for creating labels (we only use it for computer downtime) using Digi-Trax's HemaTrax Unity Client (111119 version) and the older version we used to have.  We used to have to hand create our labels prior to moving from a very old version of Meditech to Mediware (now WellSky) in 2013, so I attached our Preparation of Aliquots from 2008 because page 10 has our log for creating aliquots, pooling and sterile docking use and page 11 has the expiration date/time grid (24 hour clock).  Hopefully some or all of this helps.  
BBI0014 Labeling Blood Products_111119.doc BBI0014 Labeling Blood Products.doc BBC015.6 Preparation of Aliquots.doc

I would love step-by-step instructions on changing the expiration dates in Hematrax. We currently do not have a lab LIS, and I would hate to fumble around and screw this up. Any help will be appreciated.

In a statewide web conference, the blood suppliers in New York State and the NY metro area (parts of New Jersey) provided the reassuring news that by setting up alternate fixed sites for (mostly) whole blood collection, the blood supply has been about normal.  Platelets are collected at fixed sites and the donors have been wonderful.   Transfusion in our area (Rochester NY) is slightly down as we are not transplanting patients without urgent indications (myeloma can sometimes wait, for example) and elective surgery is not happening.  So right now, things in New York State, the worst hit part of the country, are remarkably and thankfully reasonable for blood supply.  We can thank the dedicated staff of the Red Cross and NY Blood Center, and, of course, our courageous and committed donors for this good news.  Hang in there, not that there's any other place to hang.

ARC (American Red Cross) has issued a statement that almost 5,000 blood drives were canceled and a few hundred donation sites due to quarantines. They're trying to get people to start donating at hospitals and other "essential" sites.
The physicians have ramped up elective surgery instead of delaying them. I think it's super selfish to waste blood products during a crisis of this nature when you don't know what the outcome will be or how long the quarantines will last, it's beyond frustrating.

I have to agree w John on this based on results you state.  It seems she should have received at least 3 RhIg doses after that delivery.  RhIg dose covers 30mL whole blood bleed, so there is the need for 2 doses.  In my experience we always give +1.  Doesn't sound like very good prenatal care especially if you have documented anti-D in the past (and not due to RhIg).

Based on on of this I would be inclined to believe she never had an allo anti-D. 
I am tempted to climb on my soap box and spout a heated diatribe on the prenatal practice but I think I'll skip that this time.   

I just answered this question.


My Score PASS  

Thank you for adding me!
I'm a Medical Technologist, been a generalist 13.5 years, and currently I'm over a blood bank In Georgia. Total tech years is 15 next month.
I found PathLabTalk searching for answers to my difficult blood bank questions and you guys never disappoint.

Welcome

Welcome JJSPLAYHOUSE.

I had a similar experience when a Family Practice Dr, who was chair of the OB committee at that time, brought back the Immune Anti-A, -B test.  The only 'reference' he offered was his experience with his children. We wanted to ask if those tests affected how the infants were treated, but refrained....tongue biting was involved. The pediatricians say they don't need the test.

Thank you for adding me!
I'm a Medical Technologist, been a generalist 13.5 years, and currently I'm over a blood bank In Georgia. Total tech years is 15 next month.
I found PathLabTalk searching for answers to my difficult blood bank questions and you guys never disappoint.