Brenda K Hutson

I care because we reported it out as Rh Positive (based only on GEL result; which is a Policy I am changing; will require 2 types on ALL new patients, regardless of extent of Testing Ordered). But then 1 of my Trainers used the specimen to train a student; they obtained different results (as per my description). So, we are trying to resolve it (and have also asked the patient to come back for a redraw). I also care because as I mentioned, I do not have experience with the Alba Bioscience Reagents so I am trying to understand and learn; how they work and how to interpret the results. Brenda

And to clarify from what I said....I do not consider writing an AKA on a specimen (leaving previous information intact), to be relabeling. But that being said, I never did it unless the Hospital computer system listed them as AKAs. Just can't always get a new specimen on a trauma patient, just because they now have an identity. And I definitely wouldn't do it in a situation where ALL of your trauma patients are called John or Jane Doe. Where we did this, we had unique Trauma Names. But I would contrast that for example, to things I would never allow: 1. Labelling an unlabeled specimen 2. Placing a correct label over an incorrect label 3. Adding information to an incomplete label In fact, I am known for being very rigid in specimen requirements when it comes to the Blood Bank. Brenda Hutson

I have no previous experience with Alba Bioscience Reagents (have read some of the previous discussions on this website). So, need input on this blood type: 1. 19 yr old pregnant woman (1st pregnancy) 2. GEL Card Anti-D shows kind of diffuse agglutination up the column (with a little at bottom and top) 3. Alba Bioscience "blend" is W+ positive at the Weak D phase (so that is kind of a flag for me; expect a true Weak D to be stronger??) 4. Alba Bioscience Delta D is Negative (performed Immediate Spin only) Thanks, Brenda Hutson, CLS(ASCP)SBB

Just one comment regarding the Jka reactions in GEL. This is something I discovered some years ago when first working with GEL; and found many of our clients sending to us when I was a reference lab supervisor. In GEL, you can have (not uncommonly), Jka that is non-reactive with Jka heterozygous cells; and only reacts with some homozygous cells. The fist time I saw that, the panel did not fit a pattern and everything had been ruled out on homozygous cells. So I looked to see what the positive cells had in common; only that they were all Jka homozygous. So typed patient; they were Jka NEG. PeG Panel brought the Jka up beautifully. Have run into many of these since. And this is a long-shot; but just checking to make sure you confirmed that they patient had not been transfused anywhere else since 4 mos. ago when you last saw him (as far as phenotyping)? Sorry, have nothing else to "add." Brenda Hutson

With 29 years in Blood Banking (most in CA); several large Trauma Centers..... Last place I recall, had 2 separate trays with 6 units each; 6 O NEG in one; 6 O POS in the other. When the trauma alarm went off, we would call ER to see if male or female. If male, gave O POS; if female, gave O NEG. And as others have said, if patient is bleeding out, they don't tend to make an Anti-D. In fact, I have only seen that occur once in my career, and that was not a trauma situation. That was an Rh Negative male in the OR who was bleeding and we were running out of inventory. So we switched him to O POS. The caviat with that is that you need to switch them back, "as soon as the bleeding slows down." But sometimes, you just don't know when that will be. In this guy's case, they did not request anymore units after the last O POS we gave him....uh oh. But it is a delicate balancing act. And as far as possibly giving an Rh POS unit to a trauma patient who already has Anti-D.....when you think about it, that is the risk that every patient takes when then get uncrossmatched blood. And not just with the D antigen; but with all of them. But trauma centers have to play the balancing act to keep an adequate blood supply for patients who are known to be Rh NEG; or who are known to have Anti-D; or for women of child-bearing age. Brenda Hutson, CLS(ASCP)SBB

Two things: 1. For Rh Negative pregnant (or recently pregnant) women for whom you can confirm receipt of Rhogam (recently; I like to see within past 3 months but have seen it hang out longer)...both Ortho and Immucor designate specific cells on their panel that you can use on these patients (instead of performing an entire panel). On the Ortho Panel A, look for the cells with the @ in the Special Antigen Typing column. On the Immucor Panels, look for the cells with the brackets [ ]. You will notice that these cells do not rule antigens out to the same degree that your Policy likely dictates (i.e. you will be ruling some antigens out with only 1 heterozygous cell; including C and E). If any of those cells react (since they are all D-), you will need to perform a complete panel. But I never allow that without documenting the date the patient received Rhogam (so it is confirmed). I have never run into a problem in using this. 2. As far as the frequency of repeating antibody work-ups on patients with a history of antibodies...the "optimal/ideal" is to repeat a work-up with each new specimen (provided the antibody screen is still positive). That being said, none of the 6 Hospitals (including current one), do that. I also once did a rather extensive poll to find out the frequency with which Hospitals repeated them; the most common finding was every 7 days (which would mean on a patient for whom you were receiving a specimen every 3 days, there would be 1 specimen between work-ups without a repeat antibody ID). That being said...you would have to make sure staff looked at the following: a) Does the cell(s) reacting, fit with the previously identified antibodies? Staff will need to be reminded that when Lot numbers change, so does the antigram (except for the Rh system which are the same from Lot to Lot). Has the strength of reactivity increased? If either of these changes are noted, a new work-up is in order. That being said, neither of those is a guarantee that there is not a new antibody!! And I have seen it happen. After all, titers of known antibodies can decrease; new antibodies may show dosage; you don't always see that cumulative effect; et. al. So consider that a word of caution. The "safest" thing to do would be to at least perform a minimal rule-out panel (select cell panel). You don't necessarily have to reconfirm the known antibodies; just rule-out any new ones. Brenda Hutson, CLS(ASCP)SBB

Wow, another case of responsibility being put onto the wrong people! Should not the Nurse be confirming an order to transfuse, just as she/he would an order to infuse a medication; prior to giving it?? I have never Policed it anywhere; but that being said, it has been being done at my current Institution for some time, prior to me coming (so is still in place). When a Physician enters a Transfusion Order (vs. Testing Order), it prints out to the Blood Bank computer. The Techs. then place it on the Issue counter and it is used to enter the correct Physician (the one who ordered the transfusion; which may or may not be the one who ordered the initial testing), when they come for blood products. And that has been the main issue I have come across other places; the need to enter the correct Physician requesting the transfusion. What they are asking you to do, in my mind, is not appropriate; they are asking you to do their job. Just my opinion.... Brenda Hutson, CLS(ASCP)SBB

As usual, I am "a day late and a dollar short" on replying here. So, here are some ideas for Lab Week 2013! 1. If the departments in your Lab are fairly separate (i.e. large Hospital), give a tour of your dept. to staff that do not work there. I did that once for staff in the core lab who had not worked in the Blood Bank for many years; some, not since training. I showed them "how things have changed" through the years (sending blood in pneumatic tube; GEL; electronic crossmatch; et. al.). It was actually very well received. 2. At same Hospital, the entire Lab set up a long table in a main hallway (right by one of the main entrances). Each Lab Dept. put something on display either for fun, and/or to show not only other Hospital employees, but also the public, what the Lab does. Hematology had a microscope set up with some interesting slides. Can't recall the rest. I know I had something "serious" for the Blood Bank, but also had a fun game with a nice prize basket full of goodies, which anyone could play (if non-employees, they wrote their home phone on the answer sheet). I used a blood transfer bag and cut a slit in the front of the bag; mid-section. I then filled it with Red Hot candies; then placed scotch tape over the slit. Then I made a new face label; complete with unit #, blood type, etc. and placed it over that front section. I hung it from an IV pole (as a normal transfusion) with the tubing hanging down. It was a guess how many "red cells" are in the bag. Simple, but fun. One of the things I always enjoy when I do that game (and I have done it at several Hospitals now), is staff trying to figure out how I got the candies in there (because you have covered up the slit). I try to tell them it was very difficult to squeeze 1 red hot at a time through that tubing! Brenda Hutson, CLS(ASCP)SBB

As long as they keep the MR# the same for now (give new MR# to old name also; but will merge records upon discharge), then we would still accept that specimen with the MR# that matches. Some places I have worked at, would attach a comment in the computer stating AKA (also known as....). We might then also write AKA on the specimen (with their known name) and/or any products labeled with paperwork under the Doe, John/Jane name. Just so we start thinking of the 2 interchangeably during that admission. Because for some interval, you may receive correspondence from other departments (i.e. to pick up blood products; OR) with either name. Do don't want new staff coming along to spend time trying to figure out the "discrepancy." Brenda Hutson

Sorry, just now getting back to the webiste....again. You are absolutely correct in what George Garratty believes. But I guess I am thinking that by giving complete pheno-matched, the only thing you might catch with an Alloadsorption would be a Low. But I could see the rationalization of an Autoadsorption when applicable (not as difficult as Allo; and could catch a High). And it was also my first thought when this other Specialist said she gives Pheno-matched whenever possible because she hated doing Allogeneic Adsorptions, that one should not look for ways to get out of work-ups. HOWEVER, with cost cuts these days; plus the fact I am working in a Hospital, not a Reference Lab, it is easier to look for alternatives. But I do also see the other side; that to do so is to take those valuable units that patients who actually "have" those Antibodies, need (but it is infrequent for us; so that is my rationalization for that one ). Thanks, Brenda Hutson

The original ones were very small; but now there is a larger model. Brenda Hutson

Make sure your workstations are spacious! We ended up with more space in the Blood Bank of a new Hospital (previous), but the workstations were too small. Also, one of the main doors to the Lab was right by the Blood Bank Dept. I suppose one could argue that it was convenient for people picking up blood products (though we were going to eventually start tubing blood); however, it was an automatic door that was constantly opening and closing; making it very difficult to concentrate in such a critical department. And they had made it such that at 2 of the workstations, the Tech. would be sitting with their back to the door; so everytime the door opened, they had to turn around! I finally convinced managment to let the door stay open during the day; but for security reasons, it closed again at 8pm. When moving, pack blood products as you would to ship (note:a non-Blood Bank Manager where I was, thought he could just tape the refrigerator doors shut and move the refrigerators with the blood in them; YIKES). The new Hospital had been built right next to the old; but still, you just don't do that! Depending on what functions you perform (i.e. tube blood in pneumatic tube); make sure you are located close to the object. Brenda Hutson

Question: For some reason, I think every place I have worked has used glass tubes to prepare eluates. However, I do not see that as a requirement on the Manufacturer's Insert. Does anyone know of any reason that plastic cannot be used (leaching; etc)? I wouldn't think so since blood is now drawn into plastic tubes; but don't know if the eluting solution or buffering solution (or for that matter, the working wash solution) are problematic in plastic? Thanks Brenda Hutson, CLS(ASCP)SBB:)

If this was previously covered, my apologies; I did try to search and see (ha, knowing me, I previously posted this question ) Again, not being familiar with any testing in GEL other than the Antibody Screen and Antibody Panels.....what would everyone say about DAT Testing in GEL (IgG and C3)? Thanks, Brenda Hutson, CLS(ASCP)SBB

Thanks everyone! That is helpful. Brenda

I like that! Brenda

Yep, can be...just trying to see what everyone else out there does. I guess I don't agree that the picture of the mom's serum will automatically be that of the baby (though I don't think you will miss anything by testing mom). And again, I would perform the antibody ID on the mom's serum; would just like to get a complete picture of the baby first (by Type and Screen plus DAT; when/if HDN suspected). But that is just me. Brenda

Actually, you can either give crossmatched blood, or, give Antigen Negative. I personally would still want to have a picture of what is actually going on in the baby (i.e. Type and Coombs on heelstick); then if necessary, perform Antibody ID on mom's specimen. Brenda

While I have used GEL technology for many years, I have not used it to test Eluates. However, that has been the methodology where I recently started working. Just wondering who else out there tests eluates in GEL, and what problems you may have encountered? We had one from last night that had a mixed-field "look" to it; but with cells streaming up through the GEL. I had another Tech. make a new Eluate and the testing came out the same. So I had the Tech. do Tube Testing with the Eluate and it was clean negative. So..... Thanks, Brenda Hutson

Well, I see one major reason you can better utilize the blood; you perform open hearts and are a trauma center; we are not. But other larger Hospitals in our state that fit that same description, still have problems with wastage; I mean a lot of wastage. If I had patients like the one's you described, I feel confident I could also better manage our supply. Brenda

Well, I think part of our problem (and it just hit me in looking at the great outdates you have), is that we give ALL Irradiated RBCs! Not my decision, and I am moving to change that. But that means we cannot get dates like that. However, that can't account for all of the problem because I don't think all of the other Hospitals in the state do that and yet they still have a lot of wasted products. Having never been in this situation, I am just not quite sure how to approach it (though I imagine changing our IRR Policy will help some). Thanks, Brenda

Yes, that is the system we have here; it just isn't working well for any of the Hospitals in the state; the larger overstock Hospitals, or the smaller Hospitals. The large Hospitals need to keep a fair amount of blood on hand for the types of patients they treat, and have to make sure they always have enough; there would be no quick way to stock up again. So since the large Hospitals are wasting a lot of product, they are starting to tell the smaller Hospitals NO more frequently when asked to take short-dated units. Not sure why it seems to be working out for you?? Some more questions I would ask you: 1. How large of a geographical area are you talking (in which all of the Hospitals in your system are operating)? 2. How far away is the ARC distribution center? How many miles from the center are the "closest" Hospitals? 3. If the large Hospitals are short because of bleeders, do they take the overstock blood and use it; or, is that only supposed to be used for other Hospitals? Thanks Brenda

I don't have an example to send you (do not like the one where I work now), but here are some thoughts from pervious Forms I have used (some which I revised when I went somewhere; based on past experience): 1. I like to make it a duplicate Form; 1 copy to go back with the blood and 1 to keep. Why? I recall one time where we sent the blood they requested. The Nurse then hung the blood on the wrong patient. She called us, saying that we sent her the wrong blood and that it was our fault. We had the evidence that we sent who they requested (so she then said her clerk used the incorrect patient addressograph to send for blood and that was not who she wanted; the fact that she had CLEARLY not done any of her required "checks" prior to hanging the blood, seemed to have been a minor point in her mind). 2. Have used a 1/4 sheet (carbon copy). At very top, a place for patient addressograph or sticky label (but if they use a label, must make sure they put it on both copies). Then a place for Location: ____________; then under that, I would make 2 columns; one for type of product and the other for # of that product; i.e. PRODUCT # RBCs _______ Platelets _______ etc. We then time-stamp the slip when we receive it. Brenda

Ok, thanks. I like the idea that at least someone signs the form for each unit (i.e. RN). Having seen so many Physicians over the years that suddenly "don't need uncrossmatched blood" once they realize they will have to sign for it and take responsibility, it makes me wonder what would happen if a patient had a reaction to a unit that was later "added" to a Form the Physician had initially signed.....just my paranoia getting the best of me I guess. Brenda

And having tried to work with Quality and "get" L&D to label Cords correctly, in my experience, has never gone anywhere either. As far as whether or not to use Cord Blood test results for Rhogam....I had never really thought of that in comparison to stating they cannot be used for "transfusion" purposes. I guess my rationale then in using the Rh Type of the Cord (even after my strong reply about Cord labeling errors) would be that it would not hurt the mom to get unnecessary Rhogam (excpect financially). But that being said, it does bring up the point; what if the error is the other direction; that the baby is really Rh POS (so the mom should get Rhogam), but a mislabeled Cord is received and types as Rh NEG? Something to think about....maybe. Also, just as an aside; not all places give group O only to babies. Many large Medical Centers also stock O POS, A POS, A NEG and maybe even group B. You might also get non-group O if you accept parent Directed Donors for babies (they can have very strong feelings about their baby getting blood from anyone than them; provided their type is compatible of course). Brenda Hutson