carolyn swickard

You ought to at least get him/her to the FDA accepted 6 hour limit - they have had that for years (centuries!?!). If you are in the States - you could also apply to the FDA for a variance to go to 24 hour expiration (the AABB site has an example letter). Even with very low use, that would get you in line with most other hospitals. That said, we also use a mixture of 24 hour FFPTH and 5 day plasma (converted to an additional 4 days after 24 hours, if not used). Works well and has limited our loss too. We use about 40-60 units a month.

If the situation really doesn't make sense - like Malcolm says - check an eluate from the DAT against a antibody screen trio and A cells and B cells and if you get no reactions, check the eluate against Dad's cells, if you can get them. You might also crossmatch for the infant with the eluate, some hopsitals do that too. If you can get Dad in, you might then be able to get Mom too and check her serum against Dad's cells too.

"But the score is measured out all the way to the endpoint. If this patient had 1+ on tube one, but weak reactions out to the 1:8 dilution, it would give you a score of 13 (5+2+2+2+2)." Quote This score makes some sense for the old "HTLA"s antibodies - they would go out quite a way, but be weak the whole time. Was that the antibody detected and titered?

I checked with the AABB about that "family notification" for HCV and was told that it was an error - you only have to notify family in the case of HIV if the patient is deceased. This has been corrected in the new 17th edition (just received!!) and now references the actual CFRs too.

Can I ask this question too? When you are FDA resgistered, you have two numbers - the FEI number and the CFN number. When you remove the suppliers License number and add your "registration number" for the "additional manufacturing " you do - which of those 2 numbers do you use - the FEI or the CFN????? Or does it make any difference which one you use as long as you pick one and it is barcode readable?

I try to make each "incident" a learning experience for the whole team. I figure if one person can make the mistake, there may be a weakness in the system that allows others to make the same mistake. We are a small enough team though that I usually wind up doing all of the paperwork and the Education program too.

We handle only Rhig, though that is now purchased through the Pharmacy contract for cost reasons. Pharmacy handles all of the factors and the albumin.

Just a quick point - you have to make sure that your pneumatic tube system is cabable of transporting blood before you can consider adding it to your options. Ours is way too old, too rough and the tubes are too small for any kind of padding.

Our cardiovascular surgeons routinely order 4 RBCs Xm'd, 4 FFPs on standby (not thawed) and 2 PLTPHs on standby. Their transfusion trigger for RBCs post surgery is HCT 28, a little high for current trends, but they creep along 1 unit at a time, at least. We no longer have to thaw 2 FFPs in advance because we now have a Helmer waterbath that can get the units thawed in no more than 20 minutes, but they still waste some FFP. We lose less now that we extend our unused FFPth to Thawed Plasma - gives us a little longer to use FFP they don't use. The Plts can go back to the center if not used (we have consignment priviledges - we have a Helmer plt incubator), though they frequently just get used on our oncology pts. The cadiovascular surgeons do like to see a plt count of at least 100,000 before starting surgery - can't say as I blame them. Recent trends here are for very little blood use on these surgeries anyway. More than 50% use nothing and the other 50% only use a couple of units most of the time. They were closing many surgeries with 2 FFP and 1 plt, but that has changed and is not happening much now. They used to be practically our only users of Cryo, but they use very little of that now too (just after we finally got pooled Cryo!). If your Cath Lab cardiologists are new and just learning their procedures - that may be where your problem is coming from. Things were crazy around here when we first opened our Cath Labs and many pts went straight from the Cath lab to the OR, especially the ones on ReoPro - a nasty drug. The newer drugs are more "reversable", so the pt doesn't arrive in the OR with a functional plt count of "0" - those were fun. As everyone gets more experience, hopefully things will settle down for you. They like blood and components to be "ready", but they don't have to use a lot of it and they really shouldn't waste a lot.

The Echo would work well for you - the RS3 strips only need 2 pts to be full, so most of the time they are. Little waste and what there is, is pretty cheap. The Ready-ID strips are 1 pt per run, so no waste there. The Select strips which can be used for IgG XMs and IgG DATs and Du testing, will run 4 tests each, so are usually not full, but again cheap. The CMT strips for ABORh and ABO re- check testing is 1 pt or 2 pts per strip - very little waste there. We are very happy with our Echo, especially now that Immucor is catching up with the early sales surge and the Technical people are readily availible for help and trouble shooting. They do a good job. You do need a high speed internet connection for remote diagnostics, DSL or faster (a dial-up modem will not! work at all) - so check with your computer system to make sure they will allow that if your are going to be interfaced with it (we aren't). The instrument is easy to learn and teach and most pm and midnight techs love it - easy to load and run and come back later. Solid-phase is a very sensitive method, similar to PEG - you will see antibodies on it that are non-specific. You have to get used to that and have procedures for dealing with them that do not work you to death. The only thing we are unhappy with right now is the latest software upgrade - it has caused some problems that Immucor is working on fixing (not fast enough!!) - but that happens to all software and is something you also have to live with. Good luck with your decision and your choice.

Thanks so much for the post - I have been wondering about these - when they would be ready and how to find them.

Quote - "It seems the only way to avoid doing the required IS crossmatch to detect ABO incompatibility is to take away any possibility of an ABO incompatibility in the first place...Use group O." I hope you were not really serious about that suggestion. We are already having trouble keeping up with O blood for O users in this region. Any sustained use of O blood for non-O users just for something like this seems an unjustified waste of O blood resources. Speaking as an O blood donor and an O blood user - I just can't agree with any trend like this at all. What are you going to do for your O blood users on the day you have given your last unit of O blood to an A user for a reason like this? Our donor center is already reeling from recent increases in O blood usage that they are having to investigate the reasons for - I hope they don't find a lot of new policies like this. The region is already trying to accomodate the newer CAP requirement to "make transfusion safer" where all the hospitals are getting and resulting 2 separate specimens on patients before they will release type specific blood. If they don't have the specimens they give, guess what? - O blood! When we can "make" all O blood maybe this will all make sense, but right now - I would like to be assured that that O blood will be there for my O users, myself included.

We can read the barcode into the LIS computer system at the place for band numbers (Meditech) and will eventually move to the Meditech bedside barcode verification for transfusion, but I have not seen that system and don't really know how it works. It has been discussed on this site in prior threads.

As I understand it, Typenex has two different bands now with barcodes - one is handlabeled and one uses the pt ID labels generated by computers (usually Admissions). Both have their problems - spelling and number errors on the handlabeled one and wrong pts on the printed labeled ones and no way to detect it. I prefer to use the handlabeled one, despite the redraws and we always require the presentation of the Blood bank ID wristband number before we will release RBC units. If they can't find the BB ID wristband on the pt's wrist - they can't give us the number and we can't give them blood. Nursing has even found ways around that - putting the wristband number on the chart and making copies, but hopefully errors caused by that practice will be caught by the 2 nurse reidentification of the pt at the bedside (not the nursing station!!), especially with Joint now looking for pt participation in the identification process (where possible). I don't know how the make this process error proof, but I prefer at least making them write the name and numbers instead of slapping a label on - especially if those labels may not be present at the bedside when the specimen is drawn - the problem I fear the most.

I use my 3 times yearly Automated Transfusion Survey specimens (5 specimens X 3 times/year), record the results from the Echo on a Yearly Method Correlation form I cobbled together and then test the same specimens on both tubes (all ABORhs) and 2 ABSCs and on manual Capture (3 ABSCs) - our two bench methods - and record on same form. Seems to work OK and is easy to document. :cool:

This comment was directed to the original proposal of this thread - all of the big Blood Bank systems offer a lot of training and service and updates, etc....... Certainly something that would also have to be considered by anyone developing a new system - even a small one, even a "free" one. I would also be interested in a national database for Antibodies, even though, as many have pointed out, data could get fairly weird. Does anyone at the AABB think they could host and secure such a site???

But who is going to offer the 24/7 service center needed to keep the system running and answer questions and resolve problems????

Minnesota Thermal has several sized coolers using their Thermal Isolation systems - all hold temps very well. The Thermal Isolation chambers (TICs) are much neater than the ice blocks. One suggestion - buy twice as many TICs as Igloos and you can "recharge" the TICs (in the freezer) and rotate them to the refrigerator for "conditioning" at a usable rate. If you only have as many TICs as you have Igloos - you can't recycle them fast enough. http://www.credothermal.com/. The small Golden Hour OR container is light and handy and holds temps for 4-8 hours, even with only 1 unit. They have 22C systems too for platelet transport (we have one of these too) and can even manage frozen FFP transport, but I have never seen any of those. They also work with a company that sells dataloggers and that can service and recalibrate them over time.

We once had an anti-G investigation too - so just anothr question. A reference lab I contacted said a possible way to judge whether the mother was still a candidate for RhIg was to titer the "anti-C" separately from the "anti-D". As long as the titer for the "anti-C" stayed higher than the titer for the "anti-D", it was most likely to be Anti-G and the pt was still a condidate for RhIg. Once the titer for "anti-D" passed the titer for "anti-C", there was probably a real anti-D involved and the pt would no longer be a candidate for RhIg. Any thoughts on that method - anyone else ever hear of doing it that way?

Yes they came from United Blood Services - they would come as part of any lookback notice for HCV or HIV, but if you call the Arizona Lookback coordinators, they could probably send you a set of the current letters. They have changed a little over time to reflect advances, but are designed for the general public - make that one scared recipient! hope they can help.

Hi - would have done it to begin with but am computer challenged most of the time - nice FAQ helped me out so here goes a try - this is our SOP for responding to most of the lookbacks/recalls/withdrawals that our blood distributor sends our way - 92-Notification of Transfusion Recipients.doc

We are in the process of revising this policy too - maybe we could post a few of them and compare. We have a graded policy at this time. The miscellaneous stuff our distributor sends us is graded Level 1 and the Medical Director and I decide whether to notify or not and if we notify, it is one notification to the (closest possible) attending physician and we allow the physician to decide whether to notify the patient. All exposures to infectious diseases (except HIV or HCV) are Level 2. We notify on most of them (unless the chance of exposure is really low to non-existent). We notify once and allow the physician to make the decision to contact. All HCV and/or HIV notifications or any really good chance of exposure to an infectious disease notice is a Level 3 and follows all FDA regulations for notifications. We will try to work through the physician first with notices, education material and testing offers. If the physician will not or can not participate, we attempt to notify the patient ourselves (3 tries mandatory before failure). Gives us some latitude in dealing with the distributor notices which are sometimes very weird.

As stated earlier - it is somewhat difficult to get the newer platelet pheresis products (especially the doubles) into the old style platelet rotators. The flat-bed agitators are just easier to place the big , skinny units on and have them flat, breathing on 2 full surfaces and easy to get out. Some of the older platelet rotators were "modified" to hold the pheresis units by "cutting " out some of the partitions - leaving sharp edges that can cut the pheresis units when pulled out in a hurry, or making the partitions so large the units fall out. Also, in our case, in order to have return (consignment) priviledges for platelets, we have to store them in a platelet incubator that records temps 24/7. If the incubator goes down , we still have a benchtop temp monitor with a 7 day chart, but they wouldn't let us use that for long - they prefer the incubator. Ours is a Helmer and is over 10 years old with only one repair to the flatbed agitator, which, frankly, goes 24/7.

Another thing that worries me is that Immucor just made a statement that they are going to remove the "f" pattern from their panels because so many of the cells are not antigen typed - the phenotype is "assumed" based on the entire RH typing of the test cell (hope I said that right!). Just think how many "anti-fs" will be missed when the pattern is no longer on the panel sheet! Maybe we can send this whole post off to Immucor and they will rethink their plan. Why is it that "f" doesn't cause severe HDN or severe transfusion reactions when it has been missed, I wonder? So many of the rest of the Rh system antigens are major players with those problems - why not "f"?

Is there a better test than the RPR out there now that can be used as a screening test on patients, but doesn't require a single instrument for a single test (not something my director wants to talk about)? I am so tired of the non-specificty of the RPR and it's rather weak performance overall. I would like to look at treponemal antigen specific tests that can be automated and used to monitor treatment titers, but that don't require their own specific instrument. We have a Siemens Centuar and Beckman DXs and we also have the Immucor Capture technology - but Immucor currently says that their test is only licensed for donors, not patients. Does anyone know of anything for any of these or something else that works well?